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HX64074714 
RA61 0  N48  Infant's  milk  depots 


RECAP 


INFANTS'  MILK  DEPOTS  AND 


THEIR  RELATION  TO 


INFANT  MORTALITY 


THE  NEW  YORK  MILK  COMMITTEE 

OF  THE  NEW  YORK  ASSOCIATION    FOR  IMPROVING 
THE  CONDITION  OF  THE  POOR 

105  EAST  22  nd  STREET 


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College  of  $i)pgtctan*  ano  burgeons 


Reference  lUbrarp 


BORDEN'S 
MILK 


Is  the  result  of  more  than  fifty  years'  careful  study  and 
experience  in  the  dairying-  industry,  through  the  use  of 
such  methods  as  have  been  proved  practical  for  the 
production  of  a  milk  supply  representing"  the  highest 
degree  of  cleanliness,  purity  and  quality. 

Our  milk  is  supplied  from  dairies  where  cleanliness 
is  a  science,  where  all  cows  are  regularly  examined  by 
our  competent  veterinarians,  where  the  herd  and  all 
details  connected  with  the  dairy  work  are  under  our 
control  and  the  constant  supervision  of  our  carefully- 
trained  inspectors,  and  where  all  conditions  are  such 
as  contribute  to  a  milk  supply  that  cannot  be  surpassed 
in  real  merit. 

We  keep  in  constant  touch  with  the  health  conditions 
of  all  persons  having  to  do  with  the  dairies.  All  cases 
of  contagious  or  infectious  disease  are  immediately 
reported  to  us,  and  the  supply  of  milk  from  such  sources 
is  withheld  at  our  own  financial  loss.  This  one  feature 
of  our  plan  is  of  inconceivable  value  to  our  patrons,  and 
alone  should  commend  our  products  to  every  thoughtful 
user  of  milk. 

Our  Peerless  Buttermilk  is  especially  prepared  daily 
from  this  same  supply  of  fresh,  pure,  clean  milk.  The 
process  of  preparation  converts  the  milk  sugar  into  lactic 
acid,  making  it  very  beneficial  for  use  as  a  food  and 
beverage.  In  the  light  of  recent  investigations,  which 
have  shown  the  great  value  of  lactic  acid  ferments  as 
an  aid  to  digestion,  Borden's  Peerless  Buttermilk  is 
a  product  of  great  merit. 


BORDEN'S  CONDENSED  MILK  CO. 

"Leaders  of  Quality" 

Est.  1857 


The  Sterilizing  Bottles 

used  by  the  New  York 

Milk   Committee  are 

furnished  by 

JEANNETTE 
GLASS     CO. 

J  E  ANNETTE,    PA. 

Manufacturers  of  Flint  Glass 

Bottles,  Perfumers'  Ware, 

Druggists'  PrescriptionWare 

and  Specialties 

NEW    YORK     OFFICE 
2     BARCLAY     STREET 


SHARLOW   BROTHERS 


442  West  42nd  Street  and 
439-441  West  41st  Street 
NEW   YORK    CITY 


Manufacturers  of  Crates  for 
Infants'  Milk  Bottles 


Also  Milk  Dippers,  Milk  Kettles, Measuring 

Rods,  Cream  Stirrers,  and  other 

Milk  Bottle  Carriers 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/infantsmilkdepotOOnewy 


INFANTS'  MILK  DEPOTS  AND 

THEIR  RELATION  TO 

INFANT  MORTALITY 


THE  NEW  YORK  MILK  COMMITTEE 

OF  THE  NEW'  YORK  ASSOCIATION    FOR  IMPROVING 
THE  CONDITION  OF  THE  POOR 

105  EAST  22nd  STREET 


N 


THE  NEW  YORK  ASSOCIATION  FOR  IMPROVING  THE 
CONDITION  OF  THE  POOR 


OFFICERS  AND  MANAGERS 
1908-1909 

President 
R.  Fulton  Cutting 


Percy  R.   Pyne 
Howard  Townsend 

Treasurer 
Robert  Shaw  Minturn 

Secretary 
Leonard  E.  Opdycke 

Counsel 
John   L.    Cadwalader 


Vice-Presidents 

John   Seely  Ward,  Jr. 
George  W.  Wickersham 

General  Agent 
Robert  W.  Bruere 

Supt.  Relief  Dept. 
Mrs.   Helene  Ingram 

Supt.  Fresh  Air  Dept. 
Alice  Page  Thomson 


BOARD  OF  MANAGERS 


Elected 

1877  R-  Fulton  Cutting 

1880  T.  Franklin   Smith,  M.D. 

1891  De  Witt  J.   Seligman 

1892  Robert  Shaw  Minturn 

1893  Howard   Townsend 

1893  George  W.  Wickersham 

1894  Andrew   Mills 

1895  Percy  R.  Pyne 

1895  John  Bancroft  Devins,  D.D 

1896  Leonard  E.  Opdycke 
1899  John  Greenough 
1899  Isaac  Townsend 
1899  Herbert  Parsons 
1899  Henry  G.  Barbey 
1899  Charles  Wisner 


Elected 

1900  John   Seely  Ward,  Jr. 

1900  Eugene  Delano 

1900  George  S.   Brewster 

1902  B.   Ogden    Chisolm 

1904  Albert   G.   Milbank 

1905  George  Blagden 

1905  Augustine  J.  Smith 

1906  Charles  C.  Burlingham 
1906  Victor   Morawetz 

1906  Frederick   Trevor  Hill 

1907  John  G.  Agar 

1907  Linsly  R.  Williams,  M.D. 

1907  R.  Bayard  Cutting 

1907  Frederic   P.   Moore 

1908  Franklin  B.  Kirkbride 


THE  NATION  PRESS.  20  VESEY  STREET 


THE  NEW  YORK  MILK  COMMITTEE 


GEORGE  W.  WICKERSHAM,   Chairman. 


Ernest  Hamlin  Abbott 

Hugh  D.   Auchincloss 

E.  H.  Bartley,  M.  D. 

Pres.  Nicholas  Murray  Butler 

Henry  Dwight  Chapin,   M.   D. 

Henry    Ives    Cobb 

Lewis  A.  Conner,  M.  D. 

R.  Fulton  Cutting 

Richard   Harding  Davis 

Simon  Flexner,  M.  D. 

Joseph  N.  Francolini 

Rt.  Rev.  David  H.  Greer 

E.  Eliot  Harris,  M.  D. 

Frederick  Trevor  Hill 

L.  Emmett  Holt,  M.  D. 

Loton  Horton 

Edward  F.  Hurd,  M.  D. 

John  S.  Huyler 

A.  Jacobi,  M.  D. 

Walter  W.  Law,  Jr. 

Ernst  J.  Lederle,  Ph.  D. 

V.  Everit  Macy 

A.  J.  Milbank 

Cleveland   Moffet 


Robert  C.  Ogden 

Percy  R.  Pyne 

Joseph  H.  Raymond,  M.  D. 

Mortimer  L.  Schiff 

Samuel   Sloan,  Jr. 

Charles  Sprague  Smith 

John  Spargo 

Frederick  T.  Van  Buren,  M.D. 

E.   H.  Van  Ingen 

Prof.   H.   T.  Vulte 

Rev.  William  J.  White 

EXECUTIVE  COMMITTEE: 


Stephen  G.  Williams,  Chair-man 
David   Bovaird,   M.    D. 
Robert  W.  Bruere 
Haven   Emerson,   M.   D. 
Alexander  Lambert,   M.  D. 
Charles  E.   North 
Godfrey  R.   Pisek,  M.  D. 
Charles  T.   Root 
DeWitt  J.  Seligman 
Linsly  R.  Williams,  M.  D. 


Wilbur  C.  Phillips,  Secretary. 

105  East  22d  St. 

Telephone  348  Gramercy. 


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FOREWORD. 


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The  following  report  is  intended  for  all  persons  interested  in 
saving  the  lives  of  infants.  While  it  deals  with  conditions  in 
New  York  City,  the  principles  which  it  illustrates  and  their 
method  of  application  are,  with  such  modifications  as  individual 
communities  may  require,  feasible  elsewhere. 

Experience  is  a  great  teacher,  and  those  who  build  upon  the 
experience  of  others  are  fortunate.  The  Milk  Committee  has 
so  built,  and  it  now  offers  its  failures,  its  successes,  and  its  ideas 
to  those  who  care  to  profit  by  them.  Any  information  about 
its  work  not  found  in  this  report,  will  gladly  be  sent  to  any  one 
applying  to 

Wilbur  C.  Phillips,  Secretary, 

New  York  Milk  Committee, 

105  East  22d  Street, 

New  York  City. 
Robert  W.  Bruere,  General  Agent. 

The  New  York  Association  for  Improving  the  Condition  of  the 
Poor. 


CONTENTS. 

Page 
Introduction    9 

The  Organization  of  the  Milk  Depot  Work 

(  i  )     Preliminary  steps   13 

(2)  The  milk;  its  selection,  production,  transportation  and  tests.      14 

(3)  The  formulae   20 

(4)  The  modification  of  the  milk 21 

(5)  Sanitary  methods  at  the  laboratory  22 

(6)  The  location  of  the  depots   24 

(7)  The  engaging  of  the  nurses   26 

(8)  The  preparatory  work  of  the  nurses   27 

The  Conduct  of  the  Milk  Depots    28 

The  Conduct  of  the  Consultations 32 

The  Statistical  Side  of  the  Work   36 

The  Physicians  ;  Their  Work  and  Organization 47 

The   Finances    of   the   Depots 

(1)  Initial  expenditures,  equipment,  etc 49 

(2)  The  business  maintenance  of  the  depots 52 

(3)  Relief ;  its  method  of  dispensation   53 

(4)  Cost  of  the  educational  work  54 

(5)  Financial  statement 55 

The  Work  of  the  Nurses  Not  Connected  with  Milk  Depots 57 

A  Study  of  the  Results  Obtained  by  the  Nurses  in  the  Milk 

Depots  and  by  the  Nurses  Not  Connected  with  Milk  Depots.  ...      59 
The    Experimental    Program — Facts    Shown    by    the    Summer's 

Work 
Experiment  No.    1. — What   are  the   comparative   results   obtained  by 

the  continued  use  of  pasteurized  and  of  raw  milk? 63 

Experiment  No.  2. — Which  is  the  more  economical  and  satisfactory 
method  of  saving  infants'  lives — the  purely  educational  program 
carried  on  in  connection  with  the  ordinary  milk  supply,  or  the  sale 
of  modified  milk  dispensed   by  nurses  who  ^Jso   do  instructional 

work  ?    65 

Experiment  No.  3. — Can  infants'  milk  depots  be  run  on  a  business 
basis,  and  if  not,  in  how  far  will  philanthropy  be  needed  to  support 

their  "work"  ?   69 

This  question  is  considered  under  the  following  heads : 

(1)  The  production,  handling  and  sale  of  the  milk  (business)      70 

(2)  The  investigating  and  relief  of  necessitous  cases  (philan- 
thropy)          74 

(3)  The  feeding,  instructional  and  statistical  work  (medical)      76 

(4)  The  "follow-up"  and  statistical  work    (social  or  muni- 
cipal)           77 

Summary   80 


INTRODUCTION. 

Infant  mortality,  in  the  opinion  of  most  physicians  and  social 
workers,  remains  one  of  the  biggest  problems  that  confronts 
society.  For  years,  it  has  been  the  object  of  serious  concern 
to  governments  and  municipalities,  and  has  won  the  attention  of 
physicians,  philanthropists,  milk  dealers,  sanitarians,  and  social 
workers,  not  only  in  this  country,  but  also  in  France,  Germany 
and  England.  In  spite  of  everything  that  has  been  done,  how- 
ever, the  total  number  of  deaths  among  infants  has  not  appreci- 
ably decreased.  Isolated  agencies  have  produced  results  in  cer- 
tain quarters,  but,  as  directed  against  the  whole  problem,  their 
efforts  have  been  like  those  of  scattered  whippers  in  a  forest 
fire — apparently  in  their  own  section  of  the  forest  they  have  the 
fire  under  control,  but  the  wind,  the  sparks,  the  heat,  the  draught, 
and  a  hundred  other  factors  still  remain,  each  to  assume  at  any 
moment  the  leading  role  in  the  program  of  conflagration  and 
death. 

That  this  is  so,  is  shown  clearly  in  New  York  City.  Here,  in 
unusual  abundance,  are  found  elements  to  combat  infant  mortal- 
ity. Yet  in  spite  of  all  that  has  been  done  by  philanthropists, 
milk  dispensing  agencies,  hospitals,  sanitarians,  physicians,  social 
workers  and  the  municipality,  the  number  of  deaths  of  infants 
under  one  year  of  age  in  1907  was  17,437; — that  is  to  say,  con- 
sidering the  whole  population,  rich  as  well  as  poor,  for  the  space 
of  the  entire  year,  between  140  and  150  babies  out  of  every  thou- 
sand born  died  before  they  reached  the  first  year  of  age  from 
causes  which  were  largely  preventable;  whereas,  considering  the 
poor  population  during  the  hot  weather  alone,  the  rate  in  con- 
gested quarters  was  from  200  to  400  deaths  per  thousand  births. 


io  A.  I.  C.  P. 

These  striking  figures,  which  as  far  as  actual  percentages  are  con- 
cerned, are  exceeded  in  many  other  cities,  give  some  statistical  idea 
of  the  relation  of  infant  mortality  to  our  civic  and  national  life, but 
they  can  never  portray  the  pain,  the  loneliness  and  the  wretched- 
ness of  which  they  are  merely  the  numerical  index.  To  appreciate 
their  full  meaning  is  impossible ;  it  is  beyond  human  capacity, 
and  can  only  be  understood  in  part  by  those  who  have  suffered 
bereavement  through  the  death  of  some  little  one. 

In  order  to  help  reduce  infant  mortality,  and  to  throw  light 
upon  important  matters  connected  with  it,  the  Milk  Committee 
last  spring  decided  upon  a  year's  campaign,  of  which  the  following 
is  the  first  quarterly  report.  Its  purpose,  apart  from  the  actual 
good  which  it  hoped  to  accomplish  through  the  saving  of  lives 
was  educational  and  constructive.  It  aimed  to  build  upon  founda- 
tions already  laid,  to  take  advantage  of  all  demonstrated  facts, 
rules  and  principles,  and  with  them  as  a  starting  point,  to  see  if, 
by  any  improvement,  combination  or  arrangement,  a  better  plan 
of  reducing  infant  mortality,  than  that  which  had  hitherto  exist- 
ed, could  be  worked  out. 

Of  the  truths  on  which  the  Committee  built,  the  following  may 
be  cited,  as  demonstrated  by  isolated  effort  of  other  agencies. 

i.  The  paramount  importance  of  breast  feeding,  demon- 
strated by  all  physicians  everywhere. 

2.  The  necessity  of  clean  milk  for  infants   (where  breast 

feeding  is  impossible),  demonstrated  by  Mr.  Nathan 
Straus,  Dr.  George  Goler  of  Rochester,  the  Gouttes  de 
Lait  of  France,  etc. 

3.  The  importance  of  educating  mothers  in  infant  hygiene, 
demonstrated  by  the  late  Dr.  Budin  and  the  French  Con- 
sultations de  Nourrissons. 


New  York  Milk  Committee  ii 

4.  The  value  of  field  work  by  nurses,  demonstrated  by  the 

New  York  Association  for  Improving  the  Condition  of 
the  Poor  in  its  Junior  Sea  Breeze  Campaign  of  1907, 
and  by  the  New  York  Health  Department. 

5.  The  necessity  for  philanthropic  aid,  demonstrated  by  all 

relief  and  charitable  agencies. 

It  had  also  been  demonstrated  that  the  danger  of  over-feeding 
was  fully  as  great  as  that  of  under-feeding;  that  the  question  of 
bottle  and  breast-fed  babies  is  often  a  question  of  the  mother's 
nourishment;  and  that  social  and  economic  conditions  are  an  im- 
portant element  in  the  problem.  Yet  in  spite  of  all  this  know- 
ledge, which  in  itself  would  seem  to  contain  the  solution  of  the 
question,  few,  if  any,  agencies,  engaged  in  saving  the  lives  of  in- 
fants, combined  all  or  even  a  large  number  of  these  ideas ;  indeed, 
there  was  much  disagreement,  some  experts  claiming  that  one 
factor  and  some  another  was  of  chief  importance,  so  that  not 
only  they,  but  the  public  as  well,  had  only  a  confused  idea  of  the 
true  significance  of  the  educational,  medical,  sanitary,  social, 
and  economic  aspects  of  the  problem  of  infant  mortality. 

The  Committee's  program  for  1908-9  was  divided  under  two 
heads : 

(A)  The  actual  field  work. 

(B)  The  experimental  work. 

(A)  In  its  actual  field  work  the  committee  planned  to  estab- 
lish and  maintain  seven  milk  depots  with  trained  nurses  in  charge 
of  each,  and  to  employ  in  addition  three  trained  nurses  to  do  in- 
structional field  work,  not  connected  with  milk  depots.  The  ob- 
ject striven  for  was: 

1.  The  encouragement  and  assistance  of  breast  feeding. 

2.  The  education  of  mothers  in  infant  feeding  and  hygiene 

(prevention  by  education,  carried  on  by  physicians  and 


12  A.  I.  C.  P. 

doctors  and  based  on  the  idea  of  the  French  Consulta- 
tions de  Nourrissons). 

3.  The  providing  in  the  depots  of  the  best  possible  substi- 
tute for  breast  milk,  namely,  certified  milk,  modified  in 
individual  "feedings." 

4.  The  gathering  of  important  statistics  bearing  upon  the 
problem  of  infant  mortality. 

(B)  In  its  experimental  work  the  committee  endeavored  to 
find  some  answer  to  those  questions  which  had  been  raised  most 
frequently  by  persons  interested  in  the  milk  situation,  and  which 
until  there  was  some  unanimity  of  opinion  concerning  them,  bid 
fair  to  prevent  successful  effort  in  the  saving  of  infants'  lives. 
These  questions  reduced  themselves  to  the  three  following  exper- 
iments : 
Experiment  No.  1. 

What  are  the  comparative  results  obtained  by  the  continued 
use  of  pasteurized  and  of  raw  milk. 
Experiment  No.  2. 

Which  is  the  more  economic  and  satisfactory  method  of  saving 
infants'  lives — the  purely  educational  program  carried  on  in  con- 
nection with  the  ordinary  milk  supply,  or  the  sale  of  modified 
milk,  dispensed  by  nurses  who  also  do  instructional  work? 
Experiment  No.  5. 

Can  infants'  milk  depots  be  conducted  on  a  business  basis, 
and  if  not,  in  how  far  will  philanthropy  be  needed  to  carry  on 
their  "work"? 


INFANTS'  MILK   DEPOTS    AND    THEIR  RE- 
LATION TO  INFANT  MORTALITY. 


THE  ORGANIZATION  OF  THE  MILK  DEPOT  WORK, 
(i)   Preliminary  Steps. 

The  production  of  certified  milk,  its  modification,  delivery,  and 
sale  from  infants'  milk  depots,  means  the  investment  of  a  great 
deal  of  money  and  labor.  The  amount  of  this  expenditure  varies 
with  the  magnitude  of  the  undertaking.  To  establish  and  main- 
tain seven  modified  milk  depots,  were  the  agency  so  doing  to 
own  its  own  farm,  cows,  laboratory,  horses,  delivery  wagons,  etc., 
would  involve  certainly  an  outlay  of  between  seventy-five  and  one 
hundred  thousand  dollars,  not  to  mention  the  anxiety  and  labor 
incidental  to  every  step  in  the  planning  and  equipment  of  the 
enterprise.  To  equip  a  smaller  laboratory  is  less  difficult,  but 
even  this  involves  all  the  difficulties  of  conducting  a  milk  busi- 
ness, plus  many  which  the  ordinary  milk  business  does  not  em- 
brace. 

In  opening  its  depots,  the  Milk  Committee,  as  has  been  stated, 
aimed  to  build  upon  foundations  already  laid.  This  applied  not 
only  to  accumulated  social,  hygienic,  and  medical  experience,  but 
also  to  the  experience  of  men  actually  engaged  in  the  milk  busi- 
ness. Even  had  the  Committee  been  able  to  purchase  its  own 
dairy  and  build  its  plant,  it  would  not  have  done  so  for  the  reason 
that  it  is  not  a  milk  enterprise,  but  a  social  organization.  But  be- 
cause no  other  modified  milk  dispensing  agency  was  doing  in  New 
York  City  exactly  what  the  Committee  wished  to  do,  it  was 
compelled  to  assume  responsibility  for  the  theoretical  part  of  the 
undertaking — planning  out  and  demonstrating  the  nezv  work  on 
the  foundations  of  the  old. 

Previous  to  the  commencement  of  the  undertaking,  Mr.  Loton 
Uorton,  President  of  the  Sheffield-Farms-Slawson-Decker  Milk 
Company,  had  been  elected  a  member  of  the  Milk  Committee  by 
the  Association  for  the  Improvement  of  the  Milk  Supply  of  New 


14  A.   I.   C.   P. 

York  City — an  organization  of  about  fifty  milk  dealers,  of  which 
Dr.  Ernst  J.  Lederle,  formerly  Health  Commissioner  and  a  mem- 
ber of  the  New  York  Milk  Committee,  is  a  leading  supporter,  and 
of  which  Mr".  Horton  is  president.  Mr.  Horton  had  for  some 
time  thought  of  opening  a  number  of  stores  on  the  lower  east  side, 
where  whole  milk  would  be  sold  at  reduced  prices  to  poor  people, 
and  he  consequently  was  ready  to  accept  the  proposition  later 
embodied  in  the  contract  entered  into  by  the  Sheffield-Farms- 
Slawson-Decker  Milk  Co.,  and  the  Milk  Committee  in  May,  1908. 
By  this  contract  (which  is  still  in  force)  the  Milk  Committee 
purchased  its  own  equipment,  while  the  Sheffield-Farms-Slawson- 
Decker  Milk  Company  gave  floor  space  at  its  plant  in  West  57th 
Street  as  a  laboratory,  contracted  for  the  milk,  furnished  horses 
and  truck  wagons,  and  rendered  monthly  a  true  bill  for  the  cost 
of  purchasing,  modifying  and  delivering  the  milk  without  profit 
and  exclusive  of  interest  on  invested  capital. 

(2)  The  Milk:  Its  Selection,  Production,  Transportation, 
and  Tests. 

Owing  to  the  exodus  of  people  from  the  city  in  summer  time,  a 
quantity  of  certified  milk  is  always  left  on  the  hands  of  the 
dealers  who  sell  it.  This  is  usually  sold  at  a  loss,  mixed  in 
with  the  ordinary  milk.  By  taking  advantage  of  this  surplus,  the 
Milk  Committee  was  able  at  the  outset  to  secure  as  much  certi- 
fied milk  as  it  needed,  while  the  contracting  company,  by  selling 
this  milk  at  cost,  saved  any  loss  which  might  otherwise  have  been 
incurred  through  a  shortage  of  customers. 

The  milk  chosen,  and  which  is  still  in  use,  comes  from  Tully 
Farms  in  Onondaga  County. 

Here  nature  and  enterprise  have  worked  hand  in  hand.  The 
meadows,  where  the  cows  range  at  will  during  the  spring,  summer 
and  autumn,  slope  down  to  the  shores  of  the  Tully  lakes.  A 
pure  water  supply,  a  soil  peculiarly  rich  in  grass,  and  a  lay  of 
land  which  favors  cleanliness,  meet  the  prime  requisites  of  sani- 
tary dairying.  Twice  each  month  bacteriological  tests  and  chem- 
ical analyses,  on  which  the  certification  of  milk  depends,  are  made 


New  York  Milk  Committee  15 

by  the  Syracuse  Academy  of  Medicine.  In  addition  to  these 
precautions,  every  cow  is  subjected  to  examination  by  a  veterin- 
arian at  regular  intervals.  Animals  found  unfit  to  be  milked,  from 
whatever  cause,  are  immediately  removed  from  the  herd.  To 
secure  even  further  protection,  Dr.  \Y.  H.  Leonard  of  Tully 
daily  analyzes  samples  of  the  milk  taken  at  every  stage  of  its  pro- 
duction. If  the  milk  shows  a  higher  count  than  1,000  bacteria 
per  c.  c,  investigation  as  to  the  cause  is  immediately  set  on  foot. 
Dr.  Leonard  also  maintains  a  scrupulous  oversight  of  the  farm 
lands,  the  buildings,  the  fodder  and  the  physical  condition  of  the 
men  who  come  in  contact  with  the  milk.  The  latter  have  for 
their  special  use  a  lavatory  and  a  laundry,  in  the  former  of 
which  they  bathe  and  dress  before  they  work  ;  in  the  latter  the 
white  suits  and  towels  so  extensively  used  at  the  dairy  are 
laundered  daily.  No  article  is  used  a  second  time  without  being 
washed  and  sterilized. 

The  dairy  plant  and  the  mechanical  equipment  at  the  farm  are 
constructed  according  to  the  highest  hygienic  standards.  The 
floors  of  the  dairy  building  and  the  cow  barn  are  laid  in  con- 
crete, making  it  possible  easily  to  flush  and  cleanse  them  as  many 
times  a  day  as  circumstances  require.  The  interior  fixtures  of 
the  cow  barn  are  iron,  and  therefore  impervious  to  liquids  and 
solids  likely  to  absorb  unhealthful  matter.  As  a  precaution 
against  the  accumulation  of  dust  in  mows  or  bins,  no  hay 
or  feed  of  any  kind  is  stowed  away  in  the  cow  barns,  but  is 
transported  to  the  mangers  by  means  of  a  trolley  system  con- 
nected with  the  adjacent  building.  The  King  system  of  ventila- 
tion and  an  effective  sewerage  system  furnish  pure  air  and  clean- 
liness. In  the  cow  barns  as  well  as  the  other  buildings,  an  ample 
supply  of  water,  available  from  faucet  and  hose  connection,  is 
supplied  by  gravity  from  a  chain  of  springs  connected  with  a 
spring  house. 

Before  milking,  the  cows  are  thoroughly  groomed  and  sprayed 
with  pure  water.  The  grooms  then  go  down  the  line  of  cows, 
washing  their  sides  and  udders  and  wiping  them  dry  with  steri- 
lized,  single-service  towels.     A   second  man  again  washes  and 


Why  Babies  Die 

in 
Greater    New  YorK 
Year   ending    Sept.  5,1908 

Causes  Deaths    under  I   Year 


Congenital  Debility 

i  ill-defined  Causes 

Diarrheal   Diseases 

Respiratory  Sv 
Tubercular  Diseases 

All  other  Diseases 


Rate  per 
1.000  Deaths 

3  2  9 

326 

2  2  1 

1  24 

1,000 


Urban 


Rural 


Infant  Mortality 
not  Confined  fa  Cities 

Rural  and  Urban  Districts 

United  States  :  Registration  Area    13  06 
Deaths  under  one  year 


Rate  per  1.000  total 

Urban  Deaths 

210.1 

Rate  per  1.000  total 

Rural  Deaths 

IB5.8 


>  w 

3  < 

m  D 

go  f"1 

g  h 

3  2 

w  < 

J3 


New  York  Milk  Committee  17 

dries  the  udders,  after  which  the  milkers,  in  their  white  suits  and 
carrying  their  metal  stools,  as  clean  as  parlor  furniture,  begin 
their  duties.  The  first  streams  of  "fore  milk"  are  taken  in  separ- 
ate utensils  as  a  precaution  against  the  retention  of  foreign  mat- 
ter in  the  ends  of  the  teats.  Small  topped  pails  are  used  and 
emptied  into  large  covered  cans  previously  sterilized,  in  which  the 
milk  is  carried  to  the  dairy  building  by  uniformed  assistants.  As 
fast  as  it  is  received,  the  milk  is  strained  through  a  pad  of  steri- 
lized cotton  to  eliminate  any  impurities  which  may  have  gathered 
in  its  transit.  It  is  then  run  over  a  tubular  cooler  through 
which  ice  water  is  constantly  passing  to  keep  an  even  temperature 
of  36  degrees  Fahrenheit.  At  this  temperature  it  is  put  into  forty- 
quart  cans,  which  have  previously  been  washed  and  thoroughly 
sterilized  at  the  plant.  A  boiler  and  engine  in  the  basement  of 
the  dairy  building  furnish  the  heat  and  power  for  this  purpose. 
At  all  seasons  the  milk  is  subjected  to  a  thorough  refrigerating 
process,  in  which  ice,  cut  from  the  pure  waters  of  Tully  lakes,  is 
used.  The  room  in  which  this  process  is  carried  out  is  accessible 
to  the  workers  only ;  is  rendered  dust  proof  by  seals  and  windows  ; 
and  is  moistened  high  and  low  by  sprays  of  spring  water  after  first 
being  sterilized  by  live  steam. 

The  milk  leaves  Tully  at  noontime,  reaches  New  York  City  at 
eleven  o'clock  at  night,  and  arrives  at  the  laboratory  at  a  uniform 
temperature  of  between  45  degrees  and  48  degrees  shortly  after 
twelve  o'clock.  Thus  it  is  thirty  hours  old  before  it  is  modified, 
having  been  drawn  from  the  cows  the  morning  and  evening  pre- 
ceding its  departure.  This  is  not  an  ideal  condition* — yet 
of  the  eleven  farms  supplying  the  12.000  quarts  of  certified  milk 
sold  in  Manhattan  out  of  the  two  million  quarts  of  milk  which 
come  to  New  York  City  daily,  the  Tully  Farms  bottled  milk,  on 
bacteriological  counts  made  by  the  Health  Department,  ranks 
on  an  average,  fourth  best.     Tests  of  the  modified  milk  did  not 


T*  The  requirements  for  both  guaranteed  and  certified  milk  are  that 
such  milk  shall  come  from  tuberculin  tested  cows,  shall  not  contain  more 
than  30,000  bacteria  per  cubic  centimeter,  and  that  such  delivery  shall  be 
within  36  hours  after  milking,  in  sealed  bottles,  which  have  been  filled 
at  the  dairy,  and  which  bear  the  name  of  the  dairy  and  the  date  of  the 
earliest  milking.] 


18  A   I.  C.  P. 

begin  until  August  ioth,  *  when  Dr.  Park  of  the  Health 
Department  very  kindly  offered  to  test  twelve  samples  weekly, 
six  samples  of  the  pasteurized  and  six  of  the  raw,  one  of  each 
formula,  including  the  whole  milk.  Thanks  to  these  tests,  the 
Committee  was  able  subsequently  to  discover  and  eliminate  cer- 
tain defects  in  its  laboratory  work,  which  in  spite  of  the  excellent 
character  of  the  milk  used  had,  on  one  occasion  particularly,  re- 
sulted in  the  appearance  of  several  "sick  babies"  on  its  list. 

At  present  each  separate  process  in  the  modification  and  pre- 
paration of  the  milk  in  the  laboratory  is  tested  regularly  by  a 
bacteriologist.  The  sanitary  precautions  described  on  page  22 
have  also  been  adopted,  reducing  the  danger  of  infection  to  a  min- 
imum. The  fact  that  it  is  necessary  to  bring  this  milk  to  the  city 
in  cans,  however,  renders  the  problem  of  keeping  down  the 
bacteriological  content  of  the  raw  milk  extremely  difficult. 

Tests  of  the  milk,  made  by  the  Health  Department  on  August 
24  and  August  31,  after  modification  in  the  Committee's  labora- 
tory, were  as  follows : 

Colonies  Per  Cubic  Centimeter. 
Raw  Milk  Pasteurized 

Formulae  Modified  Milk  Mod. 

Test  on  Aug.  24,  1908. 

I     19,000    IO,400 

II     460,000    IOO 

III    41,600   IOO 

IV    240,000  300 

V    45,200  500 

Colonies  Per  Cubic  Centimeter. 
Raw  Milk  Pasteurized 

Formulae  Modified  Milk  Mod. 

Test  on  Aug.  31,  1908. 

I    23,500   no   growth 

II    90,000   200 

III    29,900   1,000 

IV    23,400   300 

V    33,ooo   TOO 

[*  Owing  to  the  fact  that  the  Committee  on  June  17th  found  itself  en- 
gaged in  managing  a  retail  milk  business,  in  conducting  a  small  Health 
Department,  in  experimenting  with  a  new  system  of  relief  for  necessitous 
cases,  in  establishing  and  supervising  a  very  complex  and  difficult  statisti- 
cal work,  in  ordering  machinery,  leaflets,  ledgers,  score  cards,  charts,  lit- 
erature, etc.] 


New  York  Milk  Committee 


19 


This  milk  with  its  high  bacteriological  count  is  the  same  milk, 
treated  in  the  identical  manner  up  to  the  moment  when  it  is 
canned,  as  the  bottled  milk,  the  tests  of  which,  made  by  the  Milk 
Commission  of  the  New  York  County  Medical  Society  for  the 
three  summer  months  run  as  follows : 

Rank  arnong  certified  milk  farms 
sending  samples  same  week. 

Date  Count 

June         15   1,950  

22   400  

29   45o  

July  6   1,400   4th 

13    IP50   

20   1,100   

2.7   1,250   

August      3  1,900  

10  900  

17  4,000  

24  500  

31  500  

Sept.          7  750  

14   950  

21    1,200   

28   1,100  

This  marked  difference  between  the  canned  and  the  bottled  milk 
was  due  not  only  to  the  difficulties  of  shipment,  but  to  improper 
washing  of  bottles  (one  of  the  greatest  sources  of  infection),  and 
by  the  delay  in  building  the  Committee's  new  bottle  filler,  which 
necessitated  the  filling  of  the  bottles  by  hand.  With  the  comple- 
tion and  use  of  this  machine  ;  the  cleaning  of  the  washing  machine 
(the  plungers  of  which,  it  was  discovered,  had  become  clogged)  ; 
the  substitution  of  new  cans  for  the  old  and  somewhat  worn  cans 
used  at  the  start,  and  the  protection  of  the  milk  in  these  cans  from 
dust  by  the  use  of  a  paper  cap  under  the  cover,  the  main  causes 
for  a  high  bacteriological  content  were  subsequently  removed. 


bth 

111 

11 

3rd 

in 

12 

3rd 

m 

13 

4th 

in 

II 

3rd 

in 

II 

2nd 

n 

II 

2nd 

111 

II 

2nd 

in 

12 

3rd 

in 

II 

6th 

in 

10 

2nd 

n 

10 

3rd 

n 

12 

2nd 

n 

IO 

3rd 

n 

IO 

4th 

n 

10 

2nd 

n 

II 

20  A.  I.  C  P. 

The  last  tests  of  the  milk,  received  from  the  Health  Depart- 
ment were  as  follows :  Colonies  Per  Cubic  Centimeter. 

Raw  Milk  Pasteurized 

Formulae  Modified  Milk  Mod. 

I   300  no   growth 

II    18,000   200 

III     7,400   200 

IV    400  3,000 

V     1 ,600  200 

(3)  The  Formulae. 

In  choosing  its  formulae,  the  Committee  was  obliged  to  take  into 
consideration  the  varying  opinions  and  theories  of  physicians  in- 
terested in  infant  feeding,  and  to  select  mixtures  which,  because 
they  could  be  made  by  direct  dilution  of  whole  milk,  (thus  avoid- 
ing the  use  of  top  milks),  would  adapt  themselves  to  commercial 
preparation  on  a  large  scale.  For  summer  work,  it  was  also 
necessary  that  these  formulae  should  contain  a  low  percentage  of 
fat.*  The  choice  narrowed  down  to  two  sets  of  formulae,  one 
prepared  by  Dr.  Rowland  G.  Freeman  and  the  other  by  Dr.  L. 
Emmett  Holt. 

Dr.  Holt's  set  provided  for  five  formulae  as  follows : 

Milk    Lime  Filtered 
Fat      Suerar     Proteid  Milk     1 

1.  Very  weak 

2.  Weak 

3.  Medium   (average) 

4.  Strong  (8-12  mos.) 

5.  Strong  (over  1  yr.)  Whole  milk. 
Note. — Barley  water,  made  as  follows,  may  be  used  as  diluent  to  any 

of  the  above :  4  oz.  barley  flour  by  measure  to  water  1  gallon ;  salt  to  this 
amount — \y2   even   teaspoonfuls — grs.   90   by   weight. 

Dr.  Freeman's  formulae  were  composed  as  follows  : 

Fat     Sugar  Proteid      Milk 

1.  1.00%     6%     1.00%  1  qt. 

2.  1.50%     6%     1.50%     1  qt.  19  oz. 

3.  2.00%  6%  2.00%  2qts. 
4  3.00%  6%  3.00%  3  qts. 
5.  Whole  milk. 

Inasmuch  as  Nos.  2,  3,  and  4  of  Dr.  Holt's  formulae  were  al- 
most identical  in  their  relative  strengths  with  Nos.  I,  3,  and  4  of 


Fat      Sugar 

Proteid  Milk 

Sugar 

Water 

Water 

.50%     4.5% 

.54%     16  oz. 

6  oz. 

8  oz. 

104  oz. 

1.00%     4.5% 

•99%     32  oz. 

6  oz. 

8  oz. 

88  oz. 

2.00%     4.5% 

175%    64  oz. 

6  oz. 

8  oz. 

56  oz. 

3.00%     4-5% 

2.65%     96  oz. 

6  oz. 

8  oz. 

24  oz. 

Milk 

Lime 

Barley 

Sugar 

Water 

Gruel 

6V2  oz. 

7  oz. 

2  qts.  25  oz. 

SH  oz. 

7  oz. 

2  qts.     6  oz. 

2      oz. 

7  oz. 

1     qt.  25  oz. 

4      oz. 

7  oz. 

25  oz. 

[*  The  winter  formulae  are  being  made  with  standardized  3%  and  6% 
milk  thus  ensuring  proper  and  even  percentages  in  the  daily  supply. 
Butter  fat  tests  are  made  in  the  laboratory  daily  with  a  Babcock  ma- 
chine.    See  physicians  order  blank,  page  23.] 


Fat 

Sugar 

Proteid 

Milk 

I. 

•  5% 

6% 

•5% 

ipt. 

2. 

1% 

6% 

1% 

iqt. 

3- 

iH% 

6% 

lV2% 

1  qt.19  oz. 

4- 

2% 

6% 

2'/« 

2  qts. 

5- 

3% 

6% 

3% 

3qts. 

Lime 

Boiled 

Barley 

Water 

Water 

Gruel 

7  oz. 

3  qts.  9  oz. 

7  oz. 

2  qts.  25  oz. 

7  oz. 

2  qts.     6  oz. 

7  oz. 

1  qt.     25  oz. 

7  oz. 

25  oz. 

New  York  Milk  Committee  2i 

Dr.  Freeman's  formulae,  (the  difference  in  the  two  sets  being 
that  Dr.  Holt's  set  provided  a  very  weak  formula  for  sick  infants 
and  Dr.  Freeman's  set  provided  a  medium  formula  to  go 
between  Nos.  2  and  3  of  Dr.  Holt's  set),  it  was  decided 
for  simplicity  in  preparation,  to  add  a  weak  formula  correspond- 
ing to  Dr.  Holt's  formula  No.  1  to  Dr.  Freeman's  set,  making  the 
following  list  of  five  formulae,  containing,  with  the  exception  of 
the  first,  the  same  ingredients: 

Sugar  of 
Milk 
7  oz. 
6^oz. 
5^4  oz. 
5  oz. 
4     oz. 

(4)  The  Modification  of  the  Milk. 

There  are  five  men  working  in  the  laboratory,  a  foreman  and 
four  assistants,  three  of  whom  not  only  help  in  sterilizing  and 
filling  the  bottles,  but  also  deliver  them  at  the  different  stations. 
These  men  are  physically  examined  by  a  physician  regularly ;  they 
wear  white  suits  and  caps,  and  pay  scrupulous  attention  to  their 
personal  cleanliness,  having  for  their  use  a  lavatory  and  shower 
bath  on  the  same  floor. 

As  soon  as  the  milk  reaches  the  laboratory  the  cans  are  put  into 
a  long  box  and  surrounded  with  cracked  ice.  The  modifications 
are  then  made,  the  bottles  are  filled  and  corked,  those  that  are  to 
be  pasteurized  are  put  into  the  pasteurizer  where  the  milk  is 
heated  at  a  temperature  of  167  degrees  for  20  minutes,  and  those 
filled  with  raw  modified  milk  are  cooled  in  water  compartments  of 
decreasing  temperature,  until  finally  they  are  put  in  the  crates  and 
covered  with  cracked  ice.  In  order  to  avoid  confusion,  bottles 
containing  the  same  formulae  are  put  in  the  same  crate.  The  tag- 
ging of  these  different  mixtures  with  their  varying  quantities  of 
raw  and  pasteurized  milk  for  seven  depots  has  been  and  is  a  diffi- 
cult undertaking.  Often  there  are  as  many  as  twelve  different 
quantities  which,  multiplied  by  the  number  of  formulae  in  use, 
give  60  possible  combinations.  When  one  is  handling  2,500 
bottles  daily  as  the  Milk  Committee  does  at  present,  the  problem 
is  one  demanding  the  greatest  care. 


22  A.    I.    C.    P. 

The  prescription  orders  are  telephoned  into  the  laboratory  by 
the  different  nurses  at  the  close  of  each  day. 

(5)  Sanitary  Methods  at  the  Laboratory. 

In  safeguarding  the  handling  of  the  milk  in  the  laboratory  and 
in  protecting  from  infection  each  object  that  comes  in  contact 
with  it,  the  Committee  has  been  indebted  to  the  suggestions  of  Dr. 
Charles  E.  North,  of  the  Lederle  Laboratories.  As  soon  as  the 
men  return  from  their  morning  deliveries,  the  bottles,  turned 
upside  down  in  the  crates  as  they  are  received  from  the  depots, 
are  passed  three  times  through  the  washing  machine,  receiving 
first  a  jet  of  soda  solution,  then  a  jet  of  hot  water,  and  then  a 
scalding  rinse,  all  squirted  into  them  at  high  pressure  from  below. 
They  are  then  covered  with  cheese-cloth  and,  still  inverted,  carried 
to  the  laboratory  on  the  third  floor.  No  bottle,  can,  filler,  vat,  pail, 
receiver  or  receptacle  used  to  contain  milk  is  allowed  to  stand  un- 
covered or  to  be  exposed  to  the  air  in  any  way.  Close  meshed 
cheese-cloth  is  immediately  drawn  over  such  an  article  when  it  is 
not  in  use.  Yard  strips  of  this  cheese-cloth  (costing  5  cents 
each)  are  cut  in  halves  and  folded  over  once,  making  pieces 
a  foot  and  a  half  square,  which  may  be  used  for  various  purposes. 
As  soon  as  a  piece  has  been  used  it  is  thrown  into  a  pail  of  soda 
solution  which  is  always  near.  Each  pail  contains  a  solution  of 
Wyandotte,  two  tablespoon fuls  of  soda  to  each  pail.  Afterwards 
the  cheese-cloth  is  put  into  boiling  water  and  washed,  first  in  soda, 
then  in  hot  water,  after  which  it  is  wrung  two  or  three  times 
through  a  sterile  wringer  (not  touched  by  hand),  and  hung  over 
a  line  to  dry.  When  it  is  used  again  the  exposed  surface  is  fold- 
ed inside.  In  sterilizing  the  vats,  cans,  dippers,  pails,  scoops,  and 
other  objects  used  in  the  modifications,  the  following  process  is 
observed:  First  the  receptacle  or  object  is  scrubbed  with  soda 
solution,  a  wet  brush  being  used  with  dry  powder.  Then  it  is 
scrubbed  again  with  cold  water,  after  which  it  is  rinsed  twice 
with  tepid  water.  After  that  it  is  washed  in  hot  water  at  160 
degrees  F.  and  a  steam  hose  is  applied.  It  is  then  put  into  the 
sterilizer.    No  covers  are  used  on  milk  cans,  but  a  sterile  cheese- 


3,     '* 


r1*-*!' 


The  Bottle  Filler 


Surgical  Cleanliness  in  Preparing  the  Milk-  2  a.  m. 
THE  MILK  LABORATORY 


Adenoids — Mouth  Breathing — a  bad  condition  that  can  be  corrected 
The  "  Pacifier  " — a  bad  habit  that  baby  should  not  get 


A  Well-Fed  Baby  Needs  no  Lullaby 
GOOD  ECONOMY  TO  GET  THEM  STARTED  RIGHT 


PHYSICIAN'S  ORDER  BLANK 

INFANTS'  MILK  DEPOTS 

NEW  YORK  MILK  COMMITTEE,  A.  I.  C.  P. 

160  Mott  Street  434  East  73cl  Street 

73  Cannon  Street  246  East  82nd  Street 

412  West  47th  Street  202  Henry  Street 

146  West  100th  Street 


PRICE  PER  FEEDING 
Yi  oz. —  1  oz.       -        Vi  cent  3%  oz. —  5  oz. 

\Vi  oz. —  2  oz.       -  1  cent  5%  oz. —  8  oz. 

2/^  oz. —  3  oz.       -     1%  cents 

WINTER   FORMULAE 


2  cents 
2V<2  cents 


Prepared  from  a  Standarizt 

:d  4%    and 

6% 

Mi 

k 

No. 

Fat 

Sugar 

Proteid 

1. 

1% 

6% 

1.0  % 

2. 

W2% 

6% 

1.4% 

3. 

2% 

6% 

1.4% 

4. 

2  fe 

6% 

1.7% 

5. 

2.5% 

6% 

2.0% 

6. 

3% 

6V 

1.7% 

7. 

Whole  Milk. 

Please  furnish, 
living  at 


with  modified  milk  for  her  baby,  aged. 


Date 


Form 


Oz.  No. 

Per  Bot.    of  Bot. 


Name  of  Physician 


Mothers  whose  infants  are  prescribed  for  by  private  physicians  are  expected  to  pay 
the  full  price  for  the  milk. 

Private  physicians  are  expected  to  assume  responsibility  for  the  condition  of  infants 
fed  by  them. 

Ingredients,  in  detail,  of  the  formulae  will  be  furnished  on  application. 


24  A.  I.  C.  P. 

cloth  is  fastened  over  them  with  clothes  pins.  No  part  of  any 
receptacle  over  which  the  milk  passes  or  which  comes  in  contact 
with  the  milk  is  touched  with  the  naked  or  gloved  hands  or  is 
allowed  to  touch  any  object  which  is  not  scrupulously  clean. 
Each  morning  after  the  milk  has  been  prepared  each  foot  of  floor 
space  is  sterilized  with  steam.  These  and  other  precau- 
tions give  some  idea  of  the  care  taken  at  the  laboratory,  in 
spite  of  which,  as  has  already  been  explained,  the  bacteriological 
count  of  the  raw  milk,  during  the  early  stages  of  the  work,  was 
very  high. 

(6)  The  Location  of  the  Depots. 
In  locating  its  depots  the  Committee  took  the  following  facts 
into  consideration : 

(a)  Density  of  population. 

(b)  Nationality. 

(c)  Relation  to  cooperating  social  and  philanthropic  agen- 

cies. 

(d)  Relation  to  other  milk  dispensing  agencies. 

The  idea  was  to  find  districts  which  not  only  needed  milk 
depots,  but  which,  as  respected  living  and  racial  conditions,  would 
make  fair  comparison  possible  for  experimental  purposes.  Let- 
ters and  literature  sent  out  in  advance  to  many  churches, 
settlements  and  charitable  associations  secured  offers  of 
personal  services,  money  and  rent — in  fact  there  was  some 
little  competition  on  the  part  of  various  agencies  to  secure  the 
depots.  In  each  instance  the  needs  of  the  community  and  the 
opportunity  of  securing  the  best  results  were  the  only  factors 
considered.  Several  offers  of  rooms  splendidly  equipped  but 
poorly  located  had  thus  to  be  passed  over.  In  one  instance  a  set- 
tlement (the  East  Side  House),  whose  offer  was  declined,  itself 
organized  a  movement  to  cooperate  with  the  Committee,  and  con- 
tributed generously  to  pay  the  rent  of  a  store  situated  more  ad- 
vantageously, in  which  the  Committee  is  now  carrying  on  its 
work. 

Conforming  to  the  Committee's  experimental  program,  pas- 
teurized milk  was  sold  from  three,  and  raw  milk  from  four,  of 


BAftffOw  5T.V 


BOROUGHof/WNH/WT/IN 

Showing  Denjtftj  ofPopulah'<m 

jnd 
LOCATION  op  m  IK  PCP0T5. 

PREPARED  BY 

8UREAU  oriOCIOLOCICAL  RESEARCH 
130  MANHATTAN  ST. 
NEWYORH. 


Ket/  To  Density 

of  Population: 

□  E/nderlOO 

t^  10J  -200 

fm  201-350 

351-500 

501-650 

OverttO 


1-T5T 
lT'ST 


Key  fo/il  Jk  Depot* 

O  HY-tfilkGrnimitta. 

>fatS«nSrr«ii«f 
•    DUWtakm  An'«. 
©    Good  Swnlin  D.^ 


26  A.  I.  C.  P. 

these  depots,  the  milk  in  both  groups  coming  from  the  same 
dairy. 

The  depots  were  located  as  follows : 

Selling  modified  pasteurized  milk:  160  Mott  Street,  Italian  dis- 
trict. (Joint  depot  with  the  Diet  Kitchen  Association;  located  in 
a  store,  Committee's  share  of  rent  $12.50.) 

Selling  modified  pasteurized  milk :  262  East  Broadway,  Jewish 
and  Italian  district.  (Retail  store  of  Sheffield-Farms-Slawson- 
Decker  Milk  Company,  rent  free,  salary  of  nurse  paid  for  sum- 
mer months  by  Henry  Street  Settlement.)* 

Selling  modified  pasteurized  milk:  412  West  47th  Street,  Irish 
and  American  district.  (Basement  room  in  the  Hartley  House 
Settlement,  rent  free.  Expenses  of  installation  and  salary  of 
nurse  provided  by  Mrs.  W.  V.  S.  Thorn  for  the  first  three 
months.) 

Selling  modified  raw  milk:  73  Cannon  Street,  Jewish  district. 
(Basement  room  in  the  Alfred  Corning  Clark  House,  rent  free.) 

Selling  modified  raw  milk:  434  East  73rd  Street,  Bohemian 
district.  (Store;  rent,  $16.00  a  month,  provided  for  the  first  three 
months  by  the  social  workers  in  the  neighborhood.) 

Selling  modified  raw  milk:  246  East  82nd  Street,  Jewish  dis- 
trict.    (Basement  room  in  the  Yorkville  Dispensary,  rent  free.) 

Selling  modified  raw  milk:  146  West  100th  Street,  Irish  and 
American  district.  (Front  room  in  Bloomingdale  Guild,  rent 
free ;  Riverside  district  of  the  Charity  Organization  Society 
pledged  $1,000.00.) 

(7)  The  Engaging  of  the  Nurses. 
The  nurses  for  the  depots  were  chosen  with  care  from  a  group 
of  about  forty  candidates.     Few  of  them  had  had  social  or  field 
experience,  so  that  the  main  determining  factors  were : 

(a)  A  knowledge  of  infants. 

(b)  A  personality  which  would  attract  and  hold  mothers, 

and 

(c)  Some  apparent  fitness  for  social  work. 


[*This  depot  is  now  located  at  202  Henry  Street] 


New  York  Milk  Committee  27 

The  personality  of  the  nurse  is  a  most  important  factor,  for  no 
matter  how  intelligent  and  capable  she  may  be,  if  she  lacks  sym- 
pathy and  kindness,  her  work,  from  the  social  point  of  view, 
cannot  be  either  thorough  or  efficient. 

Language  is  another  important  factor.  When  it  began  its 
work  the  Committee  was  unable  to  find  nurses  who  could  speak 
certain  of  the  foreign  languages.  This  difficulty  was  partly  over- 
come by  securing  interpreters,  who  were  provided  in  two  cases 
by  cooperating  settlements.  The  nurses  also  nearly  always  found 
someone  in  the  family  who  spoke  English,  but  they  missed  the  ad- 
vantage of  language,  without  which  it  is  difficult  to  gain  admis- 
sion into  the  lives  of  foreign  speaking  peoples. 

(8)   The  Preparatory  Work  of  the  Nurses. 

Although  the  depots  did  not  begin  to  sell  milk  until  June  17, 
all  the  nurses  were  put  into  the  field  June  1,  in  order  that  they 
might  familiarize  themselves  with  their  neighborhoods,  open  and 
fit  up  their  stations,  and  make  sure  by  home  visitation  of  a  cer- 
tain number  of  mothers.  Announcements  of  the  proposed  "classes 
for  mothers"  were  made  from  several  pulpits,  and  various  settle- 
ments sent  out  notices. 

In  the  East  73rd  Street  depot  a  corps  of  physicians  was  or- 
ganized and  pledged  to  instructional  work  before  June  1st,  but  in 
each  of  the  other  neighborhoods  the  nurses  had  to  act  as  organ- 
izers, personally  calling  upon  physicians  and  securing  the  offer  of 
their  services  for  instructional  classes  or  consultations.  These 
physicians,  who  began  work  with  the  opening  of  the  depots,  were 
selected  largely  on  the  recommendation  of  social  workers  or  of 
other  physicians  interested  in  the  neighborhoods.  Some  had  had 
wide  experience  in  infant  feeding  and  some  had  had  little  ex- 
perience. All  of  them,  however,  spoke  the  language  of  their 
communities,  which  largely  compensated  for  the  lack  of  such 
knowldge  on  the  part  of  the  nurses. 


28  A.  I.  C.  P. 

THE  CONDUCT  OF  THE  MILK  DEPOTS. 

No  mother  who  comes  to  the  depots  can  get  the  milk  without 
first  seeing  one  of  the  Committee's  physicians,  and  making  it 
clear  that  she  is  unable  to  nurse  her  baby.  The  physician 
then  examines  the  child,  writes  a  suitable  food  prescription,  and 
secures  from  the  mother  a  promise  to  return  to  his  consultation 
regularly  each  week,  bringing  her  baby  to  be  weighed.  If  she 
does  not  do  this,  she  is  given  to  understand  that  the  milk  may  be 
refused  her. 

Each  infant  brought  to  the  depot  is  given  a  separate  sheet  in  the 
nurses'  cash  ledger,  which  covers  its  record  for  a  year.  This 
ledger  shows  day  by  day  how  many  bottles  of  milk,  what  formula 
and  what  quantity  of  milk  the  baby  is  getting,  how  much  the 
mother  is  paying  for  the  milk,  etc. 

The  pages  are  dated  uniformly  in  the  same  horizontal  columns 
so  that  the  daily  entry  for  each  child  occurs  on  a  corresponding 
line  throughout  the  book.  When  a  new  case  is  started  the  first 
entry  is  not  made  at  the  top  of  the  page,  but  in  the  column  allotted 
to  that  date  as  on  the  other  pages.  If  the  milk  is  not  called  for, 
the  column  is  left  blank.  This  shows  at  once  any  irregularity  on 
the  part  of  the  mother  in  getting  the  milk  (thus  proving  a  valu- 
able adjunct  to  the  statistical  work),  and  also  facilitates  the  mak- 
ing of  the  weekly  accounts.  A  small  card,  numbered  to  corres- 
pond with  the  ledger  page  is  given  to  each  mother  who  presents  it 
when  she  comes  for  milk ;  her  page  can  thus  be  turned  to  readily 
and  the  necessary  entries  made  without  the  necessity  of  asking 
her  name,  quantity  of  milk  wanted,  etc. 

When  a  woman  is  unable  to  pay  the  full  price  of  the  milk,  a 
memorandum  is  made  at  the  top  of  the  page  stating  the  amount 
she  is  able  to  pay  and  also  the  name  of  the  charitable  organization 
which  has  agreed  to  assist  her.  The  amount  paid  by  the  woman, 
in  accordance  with  her  agreement,  is  each  day  entered  in  the  col- 
umn "Cash  Received."  Any  deficit  on  her  part  is  entered  in  red 
ink  at  the  end  of  the  week  under  the  total  amount  of  money  she 
has  paid.  A  weekly  bill  for  the  balance  of  the  account  is  ren- 
dered to  the  relief  organization. 


IS. 


NO. 


NAME  OF  BABY 


WCMA/V  CQN  "PAY  £,*-2AU  Y 
—       A '  I.C.7>.     TfiYS  3f)L$/VCE 


ADDRESS 


•«»rrr  irini 

OATE 

Ml  LK 

■ 

BOTTLES 

Age 

Form 

Oz 

per 

Feed'g 

No. 
of 

:eed'gs 

Rale 

Asked 

Total 
Value 

Cash 
Rec'd 

Still 
Owing 

Casn 
Rec'd 

Oep. 
Rct'd 

No. 
Owing 

lite.  1 

? 

/ 

t'h 

/£ 

? 

/// 

1L 

/ 

n 

$• 

Yd 

1        ^ 

w 

% 

*0 

JA 

n 

0 

16 

// 

/% 

4 

/A 

$ 

/* 

n 

i- 

/6 

/,? 

'? 

0 

/o 

/</ 

rf/i 

•*#/v 

awes 

•an 

70 

/.f 

/(, 

ij 

ft 

/? 

P* 

?J 

/ 

m 

/ 

(FT?  "I 

/ 

/ 

1^ 

ViTi 

At"  i 

£/fL 

r  $ 

ILL 

U 

-Mi 

ZA£i 

f£2 

Tfi  7 

ft 

7?eu 

\IF 

So 

://■/ 

r   / 

'07?   ' 

*HJS 

#/n 

curt 

r 

Section  of  cash-ledger  sheet  covering  a  period  of  three  weeks.  The 
incompleted  vertical  column  of  which  this  is  the  upper  third,  contains 
spaces  for  nine  weeks.  There  are  three  of  these  vertical  columns,  con- 
taining spaces  for  twenty-seven  weeks,  on  each  side  of  the  sheet,  making 
a  total  of  fifty-four  weeks,  or  one  year,  for  the  entire  sheet. 


30  A.  I.  C.  P. 

Deposits  on  bottles  are  entered  in  the  bottle  account  under 
"Cash  Received."  Deposits. are  returned  to  women  when  they 
stop  getting  the  milk  and  the  proper  entry  made.  When  bottles 
are  not  returned  the  number  lacking  is  entered  in  the  column 
"Number  Owing." 

The  milk  arrives  in  the  depots  before  nine  A.  M. — in  some  of 
them  as  early  as  half  past  seven  A.  M.  The  ice,  which  has  been 
sold  to  the  Committee  at  a  40  per  cent,  discount  by  the  American 
Ice  Company,  usually  comes  before  this,  and  is  ready  for  distribu- 
tion with  the  milk.  The  Herald  Ice  Fund  offered  free  ice  to  the 
Committee,  providing  the  Committee  would  call  for  it  at  the  var- 
ious distributing  stations,  but  owing  to  their  distance  from  the 
milk  depots  this  was  found  to  be  impracticable. 

During  the  summer,  most  of  the  mothers  came  for  the  "little 
bottles"  with  pails  into  which  enough  ice  was  placed  to  keep  the 
milk  cool  during  transportation  to  the  home.  In  one  station  ice 
for  home-refrigeration  was  given  away  until  it  was  found  that 
mothers  well  able  to  pay  for  it  were  imposing  on  the  Committee : 
after  which  small  pieces  were  sold  (at  a  penny  each)  to  all  but 
those  who  were  found  to  be  really  indigent.  Home-made  ice 
boxes,  constructed,  for  example's  sake,  by  the  nurses  themselves, 
were  on  exhibition  at  all  the  depots  and  consultations.  These, 
for  the  most  part,  were  patterned  after  the  "Hess  refrigerator," 
and  consisted  of  wooden  boxes  stuffed  with  sawdust  or  excelsior, 
in  which,  it  was  found,  milk  kept  on  a  small  piece  of  ice  or  even  in 
cold  water  would  remain  at  a  low  temperature  for  many  hours. 
The  extent  to  which  mothers  profited — or  rather  did  not  profit — 
by  these  instructions,  is  illustrated  in  the  accompanying  table : 


Table  Showing  Use  of  Refrigerators  by  Women  who 

Attended  Milk  Depots  and  Consultations  not 

Connected  with  Milk  Depots. 

(NURSES'  ESTIMATE)* 
Depots  Selling  Pasteurized  Milk : 


MILK  DEPOT 

STANDARD 

Refrigerator 

HOME-MADE 

Refrigerator 

NO 

Refrigerator 

160  Mott  Street      -     -     - 

65% 

0 

35% 

262  East  Broadway    -     - 

75% 

5% 

20% 

412  West  47th  Street       - 

50% 

25% 

25% 

Depots  Selling  Raw  Milk: 


73  Cannon  Street  -     -     - 

25% 

0 

75% 

434  East  73rd  Street  -     - 

20% 

0 

80% 

246  East  82nd  Street  -     - 

50% 

0 

50% 

146  West  100th  Street     - 

75% 

0 

25% 

Consultations  Not  Connected  with  Milk  Depots 

•' 

248  East  105th  Street      - 

60% 

25% 

15% 

173  West  63rd  Street      - 

68% 

2% 

30% 

Most  of  the  families  that  had  no  refrigerators  kept  their  milk  in  pails 
of  cold  water,  or  used  tubs,  dish-pans,  etc.  A  few  had  the  use  of  a 
neighbor's  refrigerator.  In  one  of  the  depots,  a  Straus  Pasteurizer  was 
used  with  marked  success  for  the  double  purpose  of  heating  the  milk 
and  keeping  it  cool.  

*NOTE. — Accurate  record  of  home  refrigeration  is  made  on  the  charts 
which  the  Committee  is  now  using. 


32  A.  I.  C.  P. 

Both  ice  and  milk  were  dispensed  at  first  by  all  the  nurses. 
Toward  the  end  of  August  it  was  found  necessary  in  the  busiest 
depots  to  hire  assistants  to  distribute  the  milk  while  the 
nurse  interviewed  the  mothers  and  looked  after  their 
accounts.  Owing  to  the  complicated  bookkeeping  made 
necessary  by  the  Committee's  system  of  individual  feedings,  and 
the  value  of  a  careful  inquiry  on  the  part  of  the  nurse  into  the 
daily  condition  of  each  infant  who  uses  the  milk,  this  plan  will 
soon  be  adopted  in  all  of  the  depots.  The  avoidance  of  the  dangers 
of  over  and  under  feeding  and  of  the  upsets  occasioned  either 
by  the  milk  or  some  other  factor,  fully  compensate  for  the  addi- 
tional labor  and  expense  involved  in  this  feature  of  the  depot  ser- 
vice. 

In  one  depot,  that  conducted  jointly  with  the  Diet  Kitchen 
Association  in  Mott  Street,  raw  milk  has  been  provided  for 
nursing  mothers.  A  diet  kitchen  also  adjoins  the  Committee's 
milk  depot  in  Bloomingdale  Guild. 


THE  CONDUCT  OF  THE  CONSULTATIONS. 
Dr.  Budin,  who  established  the  first  French  Consultations  de 
Nourrisons,  once  said  that  the  two  essentials  of  a  consultation 
are  a  pair  of  scales  and  the  services  of  a  devoted  physician.  To 
these  the  Milk  Committee  has  added  an  important  third  factor — 
the  services  of  a  trained  nurse.  The  scales  used  in  the  Committee's 
consultations  were  selected  after  an  investigation  of  scales  used 
in  this  country  and  abroad.  On  the  platform  of  a  pair  of  Fair- 
banks Standard  scales,  weighing  by  ounces,  is  fastened  a  long,  flat, 
zinc  scoop,  14  x  25  inches,  turned  up  to  the  height  of 
$l/2  inches  on  the  sides  and  open  at  both  ends.  The  edges  of  this 
scoop  are  rounded.  It  rests  on  the  platform  with  its  length  par- 
allel to  the  arm  of  the  scales.  Whoever  is  using  it  thus  has  the 
baby  directly  before  and  below  him,  with  absolutely  no  danger  of 
its  falling  out.  By  having  no  ends  to  the  scoop,  the  baby  can- 
not obtain  a  purchase  with  its  feet  to  kick  or  push.  It  can  lie 
down,  sit  up  or  stand  up,  as  is  desired.  The  scales  are  accurate ; 
there  is  no  wobbling  or  vacillation,  as  is  the  case  with  needle  and 


Milk  Messengers 


Six  Bottles  of  Formula  No.  2,  for  Baby  Sixty-seven 
FROM   MILK  DEPOT  TO  THE  HOME 


^^R 

Mb    ,:- .'■',." .-■■-'  .'■  -V'  ..v. 

' 

Handicapped| 


Twelve,  Thirteen — Fourteen  Pounds 
A  POOR  START  AND  A  GOOD  ONE 


New  York  Milk  Committee  33 

basket  scales;  and  they  weigh  up  to  200  pounds.  A  napkin  is 
used,  and  over  this  is  spread  a  piece  of  tissue  paper — one  sheet 
for  each  baby. 

In  five  of  the  depots  the  consultations  have  been  held  in  the 
same  room  where  milk  has  been  dispensed.  In  Mott  Street  they 
were  held  first  in  the  chapel  of  the  Church  of  San  Salvatore ;  and 
later  in  rooms  connected  with  St.  Agnes  Settlement,  next  door  to 
the  depot.  The  nurse  connected  with  the  Sheffield-Farms-Slaw- 
son-Decker  Milk  Company's  store  in  East  Broadway  held  her  con- 
sultations at  the  Nurses'  Settlement  in  265  Henry  Street,  a  block 
and  a  half  away. 

The  hours  for  the  consultations  vary.  In  the  East  73rd  Street 
depot  one  consultation  was  held  each  day  from  11  until  12 
o'clock,  and  during  certain  weeks  of  the  summer  two  additional 
consultations  were  held  in  the  afternoon.  With  this  exception 
all  of  the  consultations  were  held  in  the  afternoon. 

The  actual  conduct  of  the  consultations  has  been  by  no  means 
uniform.  In  some  of  them  the  doctor  makes  a  short  talk  to  the 
mothers,  either  at  the  beginning  or  at  the  end ;  in  others  he  keeps 
up  a  running  fire  of  comments,  suggested  by  the  condition  of  the 
babies  as  they  come  under  his  notice ;  in  others  he  includes  in  his 
remarks  to  any  mother  as  many  others  as  come  within  range  of 
his  voice ;  in  others  the  noise  and  confusion  is  such  that  he  can 
give  only  individual  attention,  trusting  to  his  listener  to  act  as  a 
missionary  in  spreading  the  gospel  of  proper  food  and  infant 
hygiene  among  the  rest.* 

The  subjects  discussed  are  numerous,  and  embrace  the  mi- 
nutest details  of  feeding,  clothing,  ventilation,  etc.  Some  doctors 
are  of  course  better  teachers  than  others  and  are  quicker  to  win 
and  hold  the  attention  of  the  mothers.  This  is  only  another  way  of 
saying  that  trained  educators  are  needed  to  educate.** 


[*A  leaflet  describing  how  an  ideal  consultation  should  be  conducted,  is 
now  being  prepared,  and  will  be  sent  to  any  address  on  receipt  of  postage,  ] 

[**To  meet  the  demand  for  teachers  the  Association  for  Improving  the 
Condition  of  the  Poor  is  at  present  training  a  number  of  nurses  in  social 
work,  and  the  physicians  working  in  conection  with  the  Committee  are 
preparing  a  series  of  lectures  to  educate  themselves  in  infant  feeding  and 
infant  hygiene.] 


34  A.  I.  C  P. 

The  attendance  at  the  consultations  has  been  excellent.  In 
some  of  them  the  women  have  brought  their  sisters,  aunts, 
cousins  and  mothers  with  them — so  that  the  problem  of  accom- 
modating them  all  in  one  room  was  difficult.  But  the  economy  of 
instructing  fifteen  or  twenty  mothers  at  one  time,  leaving  the 
rest  of  the  day  to  the  nurse  for  follow-up  work  among  such 
cases  as  need  her  most,  far  outweighs  these  petty  annoyances. 

Some  idea  of  the  hours  of  the  consultations,  their  frequency 
and  the  average  number  of  babies  that  attended  them  may  be  ob- 
tained from  the  accompanying  table. 


O  co 

■d  S^ 


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36  A.  I.  C  P. 

THE  STATISTICAL  SIDE  OF  THE  WORK. 

In  planning  the  statistical  side  of  the  work,  the  determining  fac- 
tor was  the  necessity  of  obtaining  facts  which  would  tell  a  defin- 
ite and  concrete  story.  To  say,  for  instance,  that  of  fifty  babies 
fed  at  a  certain  depot,  fifteen  did  well,  twenty  did  fairly,  ten  did 
poorly  and  five  died,  signifies  absolutely  nothing  unless  it  is 
known  exactly  in  what  condition  those  babies  were  when  they 
were  first  taken  in  charge.  Were  they  in  perfect  condition  ?  Then 
the  report  was  one  deserving  severe  criticism.  Were  they  in  dying 
condition?    Then  it  was  excellent. 

To  overcome  this  difficulty  and  to  secure,  as  nearly  as  possible, 
uniform  employment  of  the  same  descriptive  terms  among  the 
Committee's  physicians,  it  was  decided,  after  much  deliberation, 
to  use  a  record  chart,  the  revised  edition  of  which  is  inserted  on 
the  following  page.  In  this  chart,  it  has  been  assumed  that  there 
are  seven  physical  classifications  in  which  a  child,  brought  to  the 
depots,  may  be  placed.  A  numerical  estimate  has  been  given  to 
each  of  them  as  follows: 


Moribund,      from     o — io 

Bad, 

10—25 

Poor, 

'       25—50 

Fair,                   ' 

'       50—65 

Good,                 ' 

'       65—80 

Excellent, 

'       80-^5 

Perfect, 

'       95— 100 

In  estimating  a  baby's  physical  condition,  the  doctor's  judgment 
is  thus  limited  by  the  value  of  the  descriptive  term,  chosen  with 
respect  to  all  the  others  and  to  the  upper  and  lower  limits  of  zero 
(death)  and  100  (perfect  health).  This  still  leaves  a  considerable 
range  for  the  personal  equation,  but  as  the  Committee  found  in 
experiments  made  before  the  adoption  of  the  chart,  the  "esti- 
mates" of  physicians,  trained  in  infant  feeding,  seldom  vary  more 
than  from  10  to  15  points.  With  less  trained  workers  there  is 
likelihood  of  a  wider  discrepancy,  but  even  among  these,  experi- 
ence indicates,  the  variation  can  be  minimized  by  uniformly  hold- 
ing certain  chief  characteristics  in  mind. 


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10 

ONE   BABY'S   HISTORY 
As  told  by  the  Committee's  record  charts. 

On  June  5,  Barry  O'Shea,  12  weeks  old,  came  to  the  depot 
in  Bloomingdale  Guild  on  the  point  of  death.  Almost  the  only 
thing  he  had  not  been  fed  on  was  mother's  milk.  Instead  of 
putting  him  on  the  Committee's  modified  milk,  Dr.  Wile,  senior 
physician  at  the  depot,  persuaded  the  mother  to  increase  her  own 
nourishment  and  nurse  Barry  herself.  By  so  doing  the  Com- 
mittee lost  a  customer  but  saved  the  life  of  Barry  O'Shea. 

Observe  (a)  that  Barry  weighed  only  six  pounds  and  14  ounces 
when  brought  to  the  depot  whereas  he  should  have  weighed  n| 
pounds;  (b)  that  his  life  line  rose  immediately  when  his  mother 
began  to  nurse  him  and  to  come  regularly  to  the  Committee's 
classes;  (c)  that  he  now  is  in  "perfect  health." 

Moral: — Modified  Milk  Stations  are  not  to  win  customers  but 
to  lose  them.    The  best  milk  is  mother's  milk. 


New  York  Milk  Committee  27 

In  order  to  standardize  the  curve  of  general  vitality  the  Associ- 
ation of  Physicians,  working  in  connection  with  the  depots,  has 
recently  issued  the  following  instructions:      [Appendix  A.] 

In  determining  the  value  of  work  done  by  the  physicians  em- 
ploying the  accompanying  chart,  the  plotting  of  the  curve  showing 
the  relative  general  vitality  of  the  child  from  week  to  week  is  im- 
portant. This  curve,  which  is  designed  to  show  in  graphic  form 
what  would  take  many  words  to  describe  gives  a  comparison  of  the 
child  under  treatment  with  the  normal  healthy  child  of  correspond- 
ing age.  It  is  important  to  understand  that  it  is  not  simply  a 
weight  curve,  but  that  it  connotes  and  denotes  everything  related 
to  normal  childhood. 

While  weight  is  an  important  index  to  the  condition  of  the  baby, 
an  increase  in  weight  is  not  the  only  nor  an  infallible  criterion  of 
normal  development.  Increase  in  weight  due  to  cedema  of  the  ex- 
tremities (without  explanatory  notes),  not  uncommon  in  poorly 
nourished  and  anaemic  infants,  would  give  a  false  impression  of  im- 
provement to  the  statisician.  A  fat,  flabby,  anaemic  baby,  brought 
up  on  a  rich  carbohydrate  diet  would,  judged  by  weight  alone,  ap- 
pear to  be  a  healthy  child  rather  than  one  with  low  resistance.  And 
vice-versa,  a  very  difficult  feeding  case  might  show  a  stationary  or 
vacillating  weight  on  the  chart  and  yet  gain  steadily  in  general 
vitality  and  digestion.  For  these  reasons,  weight  alone,  while  im- 
portant, is  not  a  sufficiently  true  index,  to  the  condition  of  the  baby. 

Following  are  the  chief  characteristics  which  must  be  borne  in 
mind : 

Weight: 

For  easy  reference,  a  weight  curve  of  the  normal  infant  under 
one  year  is  printed  on  the  chart.  For  practical  purposes,  the 
average  weight  of  the  normal  new-born  infant  may  be  considered 
as  7  lbs.,  which  is  usually  augmented  by  a  pound  monthly  during 
the  first  year.  Thus  the  birth  weight  is  about  doubled  at  six  months 
and  trebled  at  one  year.  During  the  second  year  the  gain  is 
usually  less,  averaging  about  six  pounds  for  the  year. 

Skin: 

Next  to  be  considered  is  the  skin;  as  to  color,  whether  normal 
pink,  or  pale  and  with  the  veins  showing  through,  or  cyanotic,  etc. ; 
as  to  texture,  whether  firm,  moist,  dry,  harsh,  wrinkled,  eczematous, 
syphilitic,  etc. 

Subcutaneous  Fat: 

At  the  same  time  the  amount  of  subcutaneous  fat  present  should 
be  noted;  well  covered  bones  and  rounded  contour  standing  for  the 
normal,  against  the  familiar  thin,  wizened,  angular,  poorly  nourished 
child. 

Musculature : 

The  development  of  the  muscular  system  is  very  important. 
Under  this  head  should  be  considered  the  condition  of  the  muscles 


38  A.  I.  C.  P. 


of  the  extremities,  whether  firm,  flabby  or  paralyzed ;  the  muscles 
of  the  abdomen,  whether  firm  and  normal  or  thin  and  ballooned 
out  by  the  intestines;  the  muscles  of  the  spinal  column,  whether, 
for  example,  the  child  can  support  its  head  on  its  trunk  (by  the 
4th  month),  whether  it  can  sit  up  alone  (by  the  7th-Qth  month), 
whether  it  attempts  to  support  weight  on  feet  (by  Qth-ioth  month), 
whether  it  stand  with  support  (by  the  nth  month),  whether  it 
begins  to  attempt  to  walk  by  the  beginning  of  the  second  year,  etc. 

Bones  and  Teeth : 

In  regard  to  the  bony  system,  aside  from  congenital  abnormalities, 
it  is  important  to  note  the  time  of  the  ossification  of  the  sutures 
and  fontanelles,  the  posterior  closing  normally  by  the  end  of  the 
second  month  and  the  anterior  by  the  end  of  the  second  year 
(usually  eighteenth  month).  Signs  of  rachitis  are  to  be  looked 
for — craniotabes,  bowed  legs,  enlarged  epiphyses,  contracted  chest, 
walls,  etc.  The  teeth  in  the  normal  child  are  usually  cut  in  a 
certain  succession,  viz. :  incisors,  then  first  molars,  then  canines, 
and  last  second  molars.  Irregularity  of  irruption  frequently  denotes 
disease  or  mal-nutrition,  while  dentition,  delayed  within  certain 
limits  without  other  symptoms,  may  be  an  idiosyncrasy  rather 
than  an  abnormality.  It  is  commonly  agreed  that  the  normal  child 
should  have  cut  six  incisors  by  the  end  of  the  first  year,  sixteen 
teeth  by  the  end  of  the  second  year,  and  all  twenty  by  the  middle 
of  the  third  year.  Premature  decay  and  deformities  (notched 
teeth,  overlapping  teeth,  etc.)  must  be  taken  into  general  con- 
sideration. 

Mental  Condition: 

Another  criterion  of  the  baby's  general  well-being  is  its  mental 
condition  and  development.  A  well-nourished  baby  sleeps  nor- 
mally and  is  happy  and  contented  when  its  necessary  wants  are 
met.  The  mental  development  of  a  given  child  varies  considerably, 
but,  in  a  general  way,  a  baby  begins  to  notice  and  grasp  objects 
by  the  second  and  third  months  and  begins  to  enunciate  single 
words  by  the  end  of  the  first  year.  "Backwardness"  may  be  an 
idiosyncrasy  or  may,  with  other  symptoms,  point  to  a  mental  defect. 

Digestion : 

The  child's  digestive  capacity  is  clearly  an  important  considera- 
tion in  determining  its  lease  on  life.  The  question  of  its  status  in 
relation  to  the  food  given  it  up  to  the  day  of  each  consultation; 
whether  it  is  or  has  been  breast  fed;  whether  fed  modified  cow's 
milk  or  proprietary  foods;  how  it  has  digested  and  thrived  on  the 
food  given;  whether  it  has  had  frequent  gastro-intestinal  upsets; 
whether  the  foods  have  had  to  be  frequently  changed,  etc.,  must 
all  be  considered.  Other  things  being  equal,  a  child  thriving  on 
breast  milk  would  be  rated  higher  than  a  child  thriving  on  modified 
milk  or  a  proprietary  food.  In  the  case  of  a  child  fed  on  modified 
cow's  milk,  the  question  must  be  considered  whether  it  can  take 
care  of  the  normal  amount  of  fat,  carbohydrate  and  proteid  for 
its  age  and  development,  or  whether  any  one  or  all  of  the  elements 
must     be    considerably     reduced     to     suit    the    lowered     digestive 


New  York  Milk  Committee  39 

capacity.     The   question  of  the  kind  of  carbohydrate   and  proteid 
also  enters ;  all  pointing  toward  a  delicate  digestive  capacity. 

Current  Diseases  and  Deformities : 

Finally  the  natural  resistance  of  the  child  as  modified  by  in- 
herited tendencies,  congenital  deformities  and  previous  and  con- 
current diseases,  must  be  weighed.  Children  delicate  from  birth  by 
reason  of  disease  of  parents;  children  with  hare-lip,  cleft-palate, 
congenital  heart  disease,  microcephalus,  hydrocephalus,  spina- 
bifida,  etc.,  etc.,  are  all  handicapped.  Also  children  suffering  with 
rachitis,  syphilis,  tuberculous  glands  and  bones,  etc.,  have  a  lowered 
resistance.  A  history  of  frequent  attacks  of  disease,  "colds," 
bronchitis,  pneumonia,  etc.,  shows  lessened  natural  resisting  power. 

The  above  does  not  pretend  to  cover  the  ground  of  all  that 
ought  to  be  taken  into  the  general  estimation  of  the  vitality  of  the 
child,  but  it  ought  to  serve  as  a  basis  for  more  uniform  expression 
of  what  we  are  trying  to  do. 

Executive  Committee, 

Association  of  Physicians 
of  the  New  York  City 
Milk  Depots. 

From  a  statistical  standpoint,  the  estimate  of  the  condition  of 
the  baby  when  it  is  received  at  the  depot  is  of  the  utmost  im- 
portance. Given  a  true  estimate,  an  agency  like  the  Milk  Com- 
mittee can  in  a  large  measure  determine  what  injury  or  profit  the 
baby  has  received  at  its  hands.  Given  a  false  estimate,  any  deduc- 
tion as  to  what  has  or  has  not  been  accomplished  is  entirely  with- 
out meaning. 

In  addition  to  the  feeding  history  and  "line  of  progress,"  the 
record  chart  originally  contained  other  facts  dealing  with  the 
question  of  infant  mortality.  Although  this  possessed  the  advan- 
tage of  giving  a  full  history  of  the  child  on  one  page,  it  proved 
confusing  because  the  responsibility  for  filling  it  out  rested  joint- 
ly with  the  physician  and  nurse,  neither  of  whom  was  under  the 
same  administrative  control.  Subsequently  it  was  deemed  wise  to 
separate  the  statistical  responsibility  of  the  physicians  from  that 
of  the  nurses,  leaving  the  record  chart  with  its  physical  history  to 
be  rilled  out  by  the  physician,  and  adding  a  social  card  (inserted 
on  the  following  page),  dealing  with  conditions  which  bear  on 
infant  mortality,  to  be  filled  out  by  the  nurse. 


40  A.  I.  C.  P. 

It  is  not  supposed,  in  obtaining  the  facts  on  this  social  card, 
that  nurses,  when  they  visit  the  homes,  will  produce  the  card, 
read  off  the  questions,  and  record  the  answers  on  the  spot.  Such 
a  proceeding  would  arouse  the  suspicion  of  mothers  and  make 
them  either  refuse  to  answer  or  to  answer  falsely.  In  the  first 
case,  valuable  material  would  be  lost.  In  the  second,  the  mater- 
ial would  not  be  such  that  any  truthful  deductions  could  be  made 
from  it.  With  intelligent  parents,  the  method  of  direct  ques- 
tioning often  proves  successful,  but  in  the  great  majority  of 
cases,  it  is  necessary  to  pesort  to  the  indirect  or  conversational 
method  of  questioning.  Any  nurse,  in  the  course  of  her  con- 
versations with  a  mother,  can,  by  a  little  exercise  of  tact  and 
intelligence,  touch  practically  upon  every  point  covered  in  the 
record  chart ;  and  after  short  practice,  can  easily  fill  in  the  moth- 
er's answers  from  memory. 

In  making  entries,  nurses  are  requested  to  observe  the  follow- 
ing instructions : 

1.  Previous  Children. 

In  specifying  the  causes  of  death  under  this  head  state  whether 
they  are  certified  (that  is,  taken  from  the  death  certificate), 
alleged  (that  is,  not  taken  from  the  death  certificate),  and  unknown. 
In  alleged  causes  please  state  source  of  information. 

2.  Nationality  of  Parents. 

In  recording  the  nationality  of  parents  use  the  following  descrip- 
tive terms,  noting  whether  persons,  declaring  themselves  to  be 
of  one  nationality,  belong  evidently  to  another;  as  for  instance, 
American-German,  Canadian-French,  American-Jew,  Canadian- 
English,  etc.  Never  enter  a  Jew  without  giving  the  country  from 
which  he  comes. 


ionalities. 

Jew 

(  Servian 

American 

Balkan-Slav   <  Bulgarian 

Canadian 

(  Croatian 

Bohemian 

French   (incl.  Belgian,  French 

Slavic   (Ruthenian) 

and  Swiss) 

Pole 

Italian  (North  and  South) 

Russian 

Spanish 

Finn 

Portuguese 

Lithuanian 

English 

Lett 

Scotch 

Caucasian 

Irish 

Hungarian 

(  Swedish 

Scandinavian  <  Norwegian 

(  Danish 

DATE-. 

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INSTRUCTIONS  FOR  FILLING  OUT  RECORD  CHART. 

(Physicians) 

A  line  of  physical  progress  (not  a  weight  curve)  should  be  drawn  from  week  to  week  with  dotted  lines  for  absences,  based  upon  the  weekly  numerical 
estimate  of  the  general  vitality  of  the  child.*  The  ideal  weight  curve  of  a  normal  child  weighing  seven  pounds  at  birth,  which  is  placed  upon  the  chart,  is  to 
assist  the  physician  in  <letermining  the  state  of  the  infant's  nutrition. 

Notes  on  the  condition  of  the  child  should  be  written  from  the  bottom  of  the  chart  upwards,  parallel  to  the  word  "notes,"  along  the  vertical  line 
running  from  zero  to  100.  Herein  should  be  entered  a  record  of  stomach  and  intestinal  disturbances.  If  the  condition  of  the  child,  as  indicated  by  the 
line  of  physical  progress,  fails  to  improve  or  deteriorates,  the  physician  should  carefully  specify  the  cause.  On  the  fullness  with  which  these  observations 
are  made  will  depend  the  statistical  value  of  the  chart,  particularly  as  concerns  the  nutritional  difference  between  raw  and  pasteurized  milk. 

"Absences,"  as  indicated  by  the  dotted  line,  should  be  accompanied  by  an  explanation  as  to  why  the  mother  was  absent  and  where  she  was. 
This  explanation  will  relieve  the  physician  from  responsibility  in  case  the  baby's  condition  failed  while  it  was  away.  Similarly  full  explanation  should 
he  given  when  the  line  stops  and  the  case  is  closed. 

The  spaces  above  the  record  chart  are  for  use  in  recording  the  number,  frequency  and  kind  of  feedings.  It  is  important  that  the  treatment  ol 
the   milk   used  should   be  carefully   indicated.      In   making  record,   use   R   for  raw,  P  for  pasteurized,  and  S  for  sterilized. 

CLINICAL  KEY. 
The  Clinical  Key  given  below  is  suggested  for  the  convenience  of  physicians  who  may  wish 
to  use  it. 

No.  1.  No.  2.  No.  4.  No.  5. 

M,lk-  Proprietary  Foods.  Food  Constituent!.  Disturbances. 

(})  Milk  dealer  a  Allenbury's  food  (See  illustrations)  v    Vomiting 

2cSv«F«n,.  b  Condensed  milk  t       Top  milk  c     Constipation 

SsC  S  B«£  extract  c       Cr£am  d    Diarrh^ea 

JifcKElttOtt™  e  fm^ri?  sm    Skimmed  milk  t     Refrigeration 

5  Mutual  Milk  &  Cr.  Co.  f  U&te&rSlV™™  pm  Peptonized  milk  (+timepept.)       ir    Insufficient  refrigeration 

6  Sheffield  Farms  g  Malt  feeding  bm  buttermilk  nr  No  refrigeration  (etc.) 

7  Sweet  Clover  Farm  h  Mellen's  food  cs     ^u?  SUgar 

8  Tlmrndale  Farm  i  Malt  soup  ms    Ml  ,k  sugar 

9  While  Clover  Farms  j  Nestles  food  s       SP 

10  Briiuvliff  Dairy  k  w      whey 

11  Walker-Gordon  1      (etc  )  sc     Sodium  citrate 

12  m.    ,  bs    Bi-carbonate  of^soda 

13  (etc.)  •*' bg    Barley  gruel 

.......  v     .  °g    Oatmeal  gruel 

/M  vi  a    e      i,  *  Additional  Foods.  Wg  Wheat  gruel 

(b)  Kind  of  milk  f  1  Orange  juice  lg     Legume  gruel 

m     Milk    (1— loose,  b— bottled)  2  Beef  juice     '  bw   Barley  water 

s     Selected  3  goup  '  ow   Oatmeal  water 

i      Inspected  4  ab    Boiled  water 

g     Guaranteed  5  ^  r    ( Rice  water 

c     Certihed  5  1     •  Lime  water]  .S33J 

sk    Skimmed  milk  7  d      Disastase  SH -"  •' 

cp   I  "iniuercially  pasteurized  8  "-  sf     Substitute  feeding 

PP    1  erfeetly  pasteurized  9  (etc.)  (at  doctor's  discretion) 

ILLUSTRATION  SHOWING  USE  OF|CLINICAL  KEY 
Sample  Formula.  Abbreviations. 

4.5  oz.  of  upper  third  of  the  milk 1 1/3  ,  „.     ,  „,„ 

4-S  5  cp=Mutual  Milk  &  Cr.  Co.'s  Milk,  commercially  pasteurized. 

1.4  o».  milk  sugar ms  „        •      ■ 

— j-^ —  f=Malted  Milk. 

1.5  01.  lime  water lw 

1  5  1 10  =  10  oz.  of  top  milk. 

15  oz.  boiled  water a'j, 

— ~^ —  d  3=  Diarrhoea,  3  days. 

.         ffl^S°e1SS  Z^ZT^'  "ST  «"»?  °f  infa°te'  ~  -P--  ■«•«*»•  APPendix  A. 


New  York.  Milk  Committee  41 

Nativity  of  Parents: — City  or  Country. 

In  determining  where  to  draw  the  line  between  a  city  and  a 
country  community,  assume  that  towns  of  'ess  than  3,000  inhabitants 
are  "country"  except  in  the  case  of  pure  factory  towns. 

Hereditary  Sickness  (Alcoholism,  syphilis,  tuberculosis,  etc.) 

As  a  guide  in  determining  the  absence  of  alcoholism,  syphilis  and 
tuberculosis,  consider  the  circumstances  of  the  births  of  previous 
children,  the  previous  occupation  of  the  parents,  and  the  present 
physical  conditions  of  the  parents.  In  making  record,  state  whether 
the  presence  of  the  sickness  is  ascertained  (in  which  case  enter  as 
"yes")  ;  suspected  (in  which  case  enter  as  "possibly"),  or  impossible 
to  discover  (in  which  case  enter  as  "unknown").  In  case  there  is 
no  sickness,  enter  as  "no."  Enter  all  other  diseases  bearing  upon 
the  health  of  the  infant,  such  as  pneumonia,  typhoid  fever  of  either 
of  the  parents  shortly  before  conception,  etc. 

Kind  and  Daily  Hours  of  Parents'  Occupation. 

In  defining  the  occupation  of  the  parents  use  the  following  de- 
nominations,  adding  detailed  description  of  zvork: 

Denominations. 

Housekeeping. 

Sewing,  millinery,  etc.    (at  home  for  private  customers). 

Home   industry    (horn  1  work   for   factory). 

Service    away    from    home     (in    private    family,    restaurant, 

janitor  or  janitress.  etc.). 
Scrubbing  away  from  home. 
Liquor  trade   (bar-tending,  etc.). 
Permanent  employment  in  laundry. 
Temporary   laundry   work    for   private   family. 
Work  in  department  store. 
Office  work  (cashier,  typewriter,  etc.). 
Street  stand  (papers,  flowers,  etc.). 
Peddling. 

Small  store  connected  with  family. 
Factory  with  less  than  20  workers. 
Factory  with  20  to  200  workers. 
Factory  with  over  200  workers. 

Care  of  Mother  Before  and  After  Confinement. 

Under  this  head  record  the  number  of  visits  made  by  any  and  all 
nurses,  and  by  any  and  all  physicians  up  to  the  day  of  birth  and 
between  the  day  of  birth  and  the  time  of  the  mother's  first  coming 
to  the  consultation.  In  confinement  cases  record  immediately  after 
birth  the  data  covering  the  prenatal  period. 

Weight  at  Birth. 

In  doubtful  cases  place  all  information  concerning  the  authenticity 
of  the   baby's   weight   as   indicated  by   the   mother   under   "alleged 
weight." 
Housing  Conditions :  Definitions  of  Terms  Used  in  Score  Card. 

District  Characteristics:     (See  accompanying  map.) 
Light:     Light  enough  to  read  easily  in  every  part  of  the  room. 
Gloomy:     Not   light    enough   to   read    easily    in    every   part,    but 
enough  readily  to  see  one's  way  about  when  doors  are  closed. 


42  A.  I.  C  P. 


Dark:  Too  dark  to  see  one's  way  about  easily  when  doors  are 
closed. 

Well  Ventilated  :  With  window  on  street  or  fair-sized  yard 
(not  less  than  12  feet  deep  for  a  five-story  tenement  house  not 
on  a  corner)  or  on  a  "large,"  "well-ventilated"  court  open  to  the 
sky  at  the  top ;  "large"  being,  for  a  five-story  tenement,  for  a 
court  entirely  open  on  one  side  to  the  street  or  yard,  not  less  than 
6  feet  wide  from  the  wall  of  the  building  to  the  lot  line;  for  a 
court  enclosed  on  three  sides  and  the  other  on  the  lot  line,  not 
less  than  12  x  24  feet,  "well  ventilated"  meaning  either  entirely 
open  on  one  side  to  the  street  or  yard,  or  else  having  a  tunnel 
at  the  bottom  connecting  with  the  street  or  yard. 

Poorly  Ventilated  :  With  window  opening  on  a  shallow  yard 
or  on  a  narrow  court,  open  to  the  sky  at  the  top,  or  else  with 
5x3  inside  window  (15  feet  square)  opening  on  a  well-ventilated 
room  in  same  apartment. 

Badly  Ventilated  :  With  no  window  on  the  street,  or  on  a 
yard,  or  on  a  court  open  to  the  sky  and  with  no  window,  or  a 
very  small  window,  opening  on  an  adjoining  room. 

Sink  Construction  :  Good — Iron,  on  iron  support  with  iron 
back  above  to  prevent  splashing  of  water  on  wall  surface,  in  light 
location,  used  for  one  family.  Water  direct  from  city  water  mains 
or  from  a  CLEAN  roof  tank. 

Bad:  Surrounded  by  wood  rims  with  or  without  metal  flushings, 
space  beneath  enclosed  with  wood  risers ;  dark  location,  used  by 
more  than  one  family ;  water  from  dirty  roof  tank. 

Poor:  Midway  between  above  two  extremes.  (Sinks  not  ex- 
actly coinciding  with  any  of  the  three  classes  are  to  be  included 
in  the  one,  the  description  of  which  comes  nearest  to  the  condition.) 

Water  Closet  Construction  :  Good — Indoor  closet.  In  well- 
lighted  and  ventilated  location,  closet  fixture  entirely  open  under- 
neath, abundant  water  flush. 

Fair:  Indoor  closet,  poor  condition.  Badly  lighted  and  venti- 
lated location,  fixture  enclosed  with  wood  risers,  or  poor  flush. 

Poor:  Yard  closet — Separate  water  closet  in  individual  com- 
partment in  the  yard. 

Bad:  School  sink — Sewer-connected  privy,  having  one  con- 
tinuous vault  beneath   the   row  of  individual   toilet   compartments. 

9.  Home  Life.     (Score  Card.) 

Base  your  estimate  of  household  cleanliness,  personal  clean- 
liness, and  good  food,  upon  your  own  experience  and  understand- 
ing of  the  sanitary  and  hygienic  conditions  under  which  a  family 
can  live  a  normal  and  healthful  life. 

10.  Knowledge  of  Infant  Hygiene. 

Measure  the  mother's  knowledge  of  infant  hygiene  according  to 
her  knowledge  of  the  information  contained  in  Miss  Mariana 
Wheeler's  "Plain  Hints  for  Busy  Mothers."  Score  mothers  who 
know  and  use  the  facts  contained  in  this  book  as  100  or  perfect. 


NAP 

OF 

Manhattan 

Showing  Disrncr  Characteristics 
forffu  rsrs"  Record  Card 

Jf.Y.MC 


Densifii-Scorp 

(OnderlOO -.  16 
100-200:10 
200-550:  6 
550-500 :  3 
SUO-650:  1 
per  650 : 0 


44  A.  I.  C.  P. 


11.  General  Intelligence. 

Base  your  estimate  of  the  "General  Intelligence  of  the  Mother" 
upon  what  you  consider  to  be  her  practical  knowledge,  as  expressed 
in  her  ability  to  run  the  household  on  the  most  rational  and 
hygienic  basis  possible  under  her  income. 

12.  Cases  of  Sickness  in  Household. 

Record  each  case  of  sickness  in  the  family  during  the  period  of 
the  mother's  care  for  the  infant.  State  whether  such  sickness,  by 
distracting  her  attention  and  by  imposing  additional  work  upon 
her,  has  a  bearing  on  the  condition  of  her  child. 

13.  Remarks. 

Enter  under  this  head  all  happenings  in  the  family  which,  in  your 
judgment  may  have  a  bearing  on  the  infant's  health  and  which  are 
not  included  in  the  questions  on  the  chart;  in  this  respect,  consider 
no  detail  superfluous. 

In  order  to  impress  upon  the  nurses  the  value  of  the  statistical 
side  of  the  work,  the  Committee  has  added  the  following  preface 
to  its  instructions : 

INSTRUCTIONS   FOR   NURSES. 

The  main  purpose  of  social  and  charitable  work  is  not  so  much 
to  relieve  people  in  suffering  as  to  prevent  suffering.  No  pre- 
ventive measure  can  be  taken  without  knowing  exactly  what  social 
conditions  produce  the  suffering  which  it  is  hoped  to  alleviate. 

The  New  York  Milk  Committee,  in  organizing  and  maintaining 
its  milk  depots,  aims  to  combat  the  abnormally  high  death  rate 
among  infants  in  the  congested  districts  in  this  city.  This  high 
death  rate  is  due  principally  to  five  causes :  hereditary  weakness, 
poverty,  industrial  conditions,  impure  milk  and  ignorance.  These 
causes  are  all  remediable,  but  they  are  changed  neither  easily  nor 
quickly.  To  destroy  poverty,  to  banish  ignorance,  to  foster  in- 
dustrial unselfishness,  to  secure  a  clean  milk  supply  and  to  develop 
a  new  and  stronger  generation,  is  a  problem  of  slow  and  tedious 
education.  Not  only  the  poor  but  the  rich  as  well  must  be  taught 
the  necessity  of  these  things.  If  reason  and  persuasion  do  not 
win  them,  then  public  opinion  must  be  brought  to  aid.  To  arouse 
public  opinion,  one  must  convince  the  public  that  conditions  ought 
or  ought  not  to  exist.  The  battle  then  becomes  an  argument ; 
both  sides  present  their  cases ;  and  the  best  side  wins.  In  this 
struggle,  hearsay,  opinion,  and  information  which  cannot  be  relied 
upon  are  of  no  avail.  Facts  alone  have  weight.  These  facts  must 
be  unquestionable.  As  nearly  as  possible  they  must  be  absolute. 
If  they  are  untrustworthy,  and  easily  disproved — if  the  case  cannot 
be  won  on  them — they  are  useless. 

The  duty  of  collecting  facts  therefore  is  most  important,  for  on  it 
depends  all  social,  physical,  industrial  and  moral  advancement.  Each 
individual  collector,  however  insignificant  his  or  her  work  may  seem, 


New  York  Milk  Committee  45 


contributes  definitely  to  this  great  movement,  and  by  each  added 
figure  piles  up  the  sum  of  evidence  which  is  necessary  to  change 
conditions. 

The  facts  sought  by  the  New  York  Milk  Committee  have  been 
selected  under  advisement  of  an  expert  statistician  and  after  con- 
ferring with  many  authorities  on  Infant  Mortality.  In  the  case 
of  Society  versus  Poverty,  Ignorance,  Cupidity  and  Disease,  each 
of  these  facts,  as  far  as  trained  knowledge  can  decide,  is  indis- 
pensable. Taken  together,  they  constitute  a  chain  of  evidence 
which  will  secure  a  verdict  in  direct  proportion  to  the  strength 
of  each  link.  It  is  essential  therefore,  not  to  get  half  or  two-thirds 
or  even  nine-tenths  of  the  facts  striven  for,  but  to  get  them  all. 

The  Committee  has  sought  to  arouse  a  personal  interest  in  sta- 
tistics on  the  part  of  the  nurses  by  the  following  questions: 

1.  Nationality  of  Parents. 

Should   immigration  be   checked? 

Are  some  nationalities  more  desirable  than  others?  More 
immune  against  disease?    Which  ones?    Why? 

Do  you  believe  it  is  more  difficult  to  save  the  lives  of  Italian 
and  Yiddish  babies,  than  to  save  the  lives  of  American  babies? 

Do  you  think  that  a  wider  knowledge  on  these  matters  would 
help   remedy   conditions? 

Fill  out  the  record  charts. 

2.  Urban  and  Rural  Nativity  ;  Residence  of  Parents. 

Is  the  country  healthier  than  the  city? 
Does  city  residence  shorten  the  period  of  life? 
Is  it  either  natural  or  desirable  to  live  in  congestion? 
Should  conditions  in  congested  districts  be  remedied  or  should 
people  be  induced  to  leave  such  districts? 

What  do  you  think  is  an  ideal  place  in  which  to  live? 
Would  you  like  others  to  think  as  you  do? 
Fill  out  the  record  charts. 

3.  Kind  and  Daily  Hours  of  Parents'  Occupation. 

Does  employment  (its  kind  and  hours)  affect  the  pregnant 
mother?     The  nursing  mother?     The  baby? 

Does  the  father's  salary  have  any  effect  upon  the  mother  and 
child?  .     .  . 

Do  you  know  of  any  mother  whose  work  is  injurious  to  herself 
and  to  her  child? 

Would  you  like  others  to  realize  certain  conditions  as  you  realize 
them? 

Fill  out  the  record  charts. 

4.  Previous  Sicknesses  in  Family. 

Do  you  believe  in  heredity? 

Can    the    next    generation    be    made    stronger    than    the    present 

generation?  ....■«  ,  •,      t? 

Does     Society    pay    for    immorality?     For     drunkenness.1'      tor 

tuberculosis?    How?  . 

Would  you  like  others  to  share  your  own  definite  ideas  on  these 

matters? 

Fill  out  the  record  charts. 


46  A.  I.  C.  P. 


5.  Illiteracy. 

Is  education  desirable? 

Is  it  responsible  for  health,  for  happiness,  for  life? 
Would   you   like  to   see   any  of  your   mothers   better   educated? 
Why? 
How  could  this  be  done? 

Does  every  one  think  as  you  do  on  these  matters? 
Fill  out  the  record  charts. 

6.  Care  of  Mother  Before  and  After  Confinement. 

Is  it  true  that  mothers  need  care  before  and  after  confinement? 

Do  you  know  of  any  mother  who  suffered  because  she  did  not  re- 
ceive such  treatment?     How? 

Did  it  affect  her  infant? 

What  could  have  been  done  to  help  her? 

To  help  other  mothers  under   similar  conditions? 

Would  it  be  well  if  Society  understood  some  of  these  matters 
as  you  understand  them? 

Fill  out  the  record  charts. 

7.  Housing  Conditions. 

Are  rents  too  high  in  the  neighborhood  in  which  you  work?  Is 
the  neighborhood  congested  ? 

Are  the  houses  in  good  condition?     Are  they  overcrowded? 

Would  you  like  to  live  in  the  neighborhood?     In  the  houses? 
If  not,  why  not? 

Whose  fault  is  it  that  these  conditions  are  not  better? 

Do  these  conditions  affect  any  of  the  babies  that  come  to  you  ? 

Do  you  wish  to  help  in  changing  these  conditions? 

Fill  out  the  record  charts. 

Home  Life. 

Do  the  mothers  who  come  to  you  know  how  to  cook? 
Do  they  keep  house  as  well  as  your  own  mother? 
How  many  clean,  well-fed  families  are  there  on  your  list? 
Why  are  not  the  dirty  families  clean  and  well-fed? 
If    they    were    clean    and    well-fed,    would    they    be    happier? 
Healthier  ? 

Would  they  live  longer? 

Would  you  like  to  assist  them  to  become  cleaner  and  better  fed? 

Fill  out  the  record  charts. 


New  York  Milk  Committee  47 

THE  PHYSICIANS— THEIR  WORK  AND  ORGANIZATION. 

On  August  31,  twenty-nine  volunteer  physicians  were  engaged 
in  instructional  work  connected  with  the  depots.  At  their  classes, 
these  doctors,  assisted  by  the  nurses,  weigh  the  babies,  prescribe 
the  feedings,  and  instruct  the  mothers  in  infant  hygiene.  On  July 
2 1st,  the  physicians  organized  themselves  into  "The  Association 
of  Physicians  of  the  New  York  City  Milk  Depots."  The  objects 
of  this  Association  (quoted  from  its  constitution)  are  as  follows: 

(a)  The  reduction  of  infant  mortality  by  the  encourage- 
ment of  breast  feeding  and  the  education  of  mothers 
in  infant  hygiene. 

(b)  The  gathering  of  information  which  will  make  a  more 
intelligent  and  effective  campaign  against  infant  mor- 
tality possible. 

(c)  The  working  out  of  the  principles  of  infant  feeding  and 
a  system  of  hygienic  instruction  to  mothers,  capable  of 
general  expansion  and  development. 

(d)  The  bringing  about  of  a  spirit  of  cooperation  and  mutual 
assistance  on  the  part  of  physicians,  milk  dealers,  and 
all  persons  interested  in  social,  physical,  and  moral  pro- 
gress. 

The  Association  chose  for  its  chairman  Dr.  G.  R.  Pisek, 
Chairman  of  the  Pediatric  Section  of  the  Academy  of  Medicine, 
who  has  taken  an  active  interest  in  the  Committee's  work  from  the 
beginning,  and  who  personally  organized  and  supervised  the  work 
of  its  East  73rd  Street  depot.  In  order  to  coordinate  all  branches 
of  the  work,  the  Association  also,  by  a  suspension  of  its  constitu- 
tion, first  elected  Mr.  Phillips,  Secretary  of  the  Milk  Committee,  to 
its  membership  and  then  made  him  its  secretary  and  delegate  to  co- 
operating organizations.  The  executive  committee,  consisting  of 
five  members,  including  the  chairman  and  secretary,  directs  and 
supervises  the  instructional  and  statistical  administration  of  the 
depots.  This  committee  consists  of  Dr.  Pisek,  Mr.  Phillips,  Dr. 
Ira  S.  Wile,  Secretary  of  the  Riverside  District  of  the  Charity 
Organization  Society,  Dr.  Herman  B.  Sheffield  of  the  Yorkville 
Dispensary,  and  Dr.  Anna  I.  Von  Sholley,  visiting  physician  of 


48  A.  I.  C.  P. 

the  N.  Y.  Infirmary  and  the  only  woman  physician  in  the  Asso- 
ciation. 

The  meetings  of  the  Association  held  so  far  have  been  unusual- 
ly well  attended,  and  show  a  keen  interest  on  the  part  of  the  physi- 
cians in  the  work  which  they  are  helping  the  Committee  to  carry 
on.  The  instructions  for  filling  out  the  physicians'  feeding  chart, 
and  for  standardizing  the  curve  of  general  vitality  (already  de- 
scribed under  the  head  of  statistics),  were  both  drawn  up  by  the 
Association,  which,  in  addition,  is  now  taking  up  the  matter  of 
the  conduct  of  the  consultations,  of  limiting  the  instructional 
capacity  of  the  depots,  of  appointing  senior  physicians  to  consult 
with  the  younger  men,  and  with  the  assistance  of  an  expert 
statistician,  of  perfecting  the  statistical  side  of  the  work,  so  that 
no  part  of  the  year's  effort  will  be  lost.  It  is  also  planning  a 
series  of  lectures  on  infant  feeding  and  infant  hygiene,  to  be 
given  to  its  members  and  other  physicians  who  may  care  to  at- 
tend, by  physicians  making  a  specialty  of  these  subjects.  Later 
it  will  make  a  report  on  its  work. 


New  York  Milk  Committee  49 

THE  FINANCES  OF  THE  DEPOTS. 
(i)      Initial  Expenditures,  Equipment,  Etc. 

In  equipping-  its  laboratory,  the  Committee  tried  to  be  as  eco- 
nomical as  was  consistent  with  thorough  work .  To  avoid  the  labor 
of  ordering  each  separate  machine,  it  placed  an  order  for  the 
general  equipment  of  its  laboratory  with  the  Dairy  Machinery 
and  Construction  Co.  of  Shelton,  Conn.,  reserving  for  itself  the 
work  of  ordering  crates,  bottles,  corks,  refrigerators,  and  a  few 
other  items. 

Mr.  Horton,  President  of  the  Sheffield-Farms-Slawson-Decker 
Milk  Company,  acting  under  the  terms  of  his  contract,  provided 
the  Committee  with  two  delivery  wagons,  which,  with  horses 
and  harnesses,  represent  an  expenditure  of  about  $1,000.00. 

The  time  it  saved  in  these  matters  did  not  relieve  the  Committee 
from  a  great  deal  of  anxiety  and  responsibility. 

Inasmuch  as  the  glass  factories  closed  in  June,  and  did  not  open 
until  the  middle  of  September,  the  Committee,  which  was  unable 
to  foresee  the  number  of  babies  which  it  might  be  called  upon  to 
feed,  placed  an  order  for  bottles  considerably  in  excess  of  the 
actual  number  which  it  needed.  The  supply,  however,  is  suf- 
ficient to  last  it  for  some  time — for  a  year  at  least.  Similarly, 
ignorance  and  caution  prompted  the  ordering  of  too  many  crates. 
These  surplus  expenditures  are  interesting  because  they  were 
made  at  the  advice  of  those  who  had  had  wide  experience  in  infant 
feeding.  The  Committee  knew  that  other  modified  milk  dispens- 
ing agencies,  even  those  operating  for  only  a  few  months  in  the 
summer,  were  as  a  rule  deluged  with  babies.  But  it  did  not  take 
into  sufficient  account,  the  consequence  either  of  the  emphasis 
which  it  had  determined  to  place  upon  breast  feeding  as  opposed 
to  bottle  feeding,  or  of  the  fair  price  for  an  expensive  milk  which 
it  had  determined  to  charge.  Contrary  to  the  usual  experience, 
the  depots,  although  located  in  congested  quarters  of  the  city, 
came  through  the  first  quarter  of  the  year  with  a  daily  average  of 
less  than  fifty  babies  to  the  depot.  This,  the  Committee  believes, 
is  a  result  to  be  proud  of,  rather  than  deplored.  It-  main  object, 
in  other  words,  is  not  to  increase,  but  to  decrease,  the  number 


SO  A.  I.  C  P. 

of  bottle  babies,  and  once  it  has  ascertained  the  actual  number 
of  bottle  babies  in  the  neighborhood,  a  rise  in  the  sale  of  modified 
milk  is  an  indication  of  failure. 

The  bottles  selected  are  in  three  ounce,  six  ounce,  and  eight 
ounce  sizes,  similar  to  the  Straus  bottles,  with  rounded  bot- 
toms, short  necks  and  a  wide  spread  at  the  top,  permitting  easy  ac- 
cess of  water  and  brush  for  sterilizing  purposes.  Grooved  corks 
are  used  for  filling,  and  are  thrown  away  after  each  service.  At  the 
depots,  mothers  are  required  to  make  a  deposit  of  two  cents  on 
each  bottle.  This  encourages  care  in  handling,  and  saves  the  Com- 
mittee considerable  loss  in  breakage.  In  spite  of  this  precaution, 
however,  the  average  life  of  a  bottle,  as  nearly  as  can  be  estimated, 
is  less  than  ten  fillings.  This  is  no  doubt  due  to  the  large 
amount  of  handling  required  by  the  Committee's  system  of 
individual  prescriptions.  It  may  also  be  caused  in  part  by  the 
tightness  with  which  the  bottles  fit  into  some  of  the  crates.  The 
latter  are  of  three  sizes,  adapted  to  the  three  sized  bottles.  They 
are  hand  made,  of  galvanized  iron,  making  an  open  framework 
for  the  bottles,  through  which  the  water  runs,  leaving  the  crates 
dry  and  clean.  It  would  have  been  much  better  if  the  crates  had 
been  of  the  same  size  and  if  the  compartments  for  individual 
bottles  had  been  made  on  an  equal  center,  so  that  the  three  ounce, 
six  ounce  and  eight  ounce  bottles  would  have  adapted  themselves 
exactly  to  the  same  filling  and  sterilizing  machines.  This  is  one 
of  the  experiences  which  the  Committee  has  paid  for  and  which  it 
tells  in  order  that  others  may  not  repeat  its  mistake.  As  it  is, 
there  are  two  compartments,  not  only  in  the  bottle  filler,  but  also 
in  the  bottle  washer — one  compartment  having  plungers  fitted 
to  the  three  ounce  and  six  ounce  bottles,  and  the  other  compart- 
ment having  plungers  fitted  to  the  eight  ounce  bottles.  From  the 
combined  standpoint  of  delivery,  packing,  filling,  washing,  and 
space  occupied,  the  economy  of  similar  sized  crates  built  on  com- 
mon centres  for  all  bottles  is  apparent. 

In  order  to  modify  the  milk  in  individual  prescriptions,  Mr. 
Joseph  Willman,  President  of  the  Dairy  Machinery  and  Construc- 
tion Company,  devised  a  bottle  filler  capable  of  filling  any  quan- 


New  York  Milk  Committee  51 

tity  desired,  from  one  half  an  ounce  to  eight  ounces.  This  machine 
was  constructed  after  two  months'  delay,  but  proved  inadequate, 
inasmuch  as  the  mechanical  arrangement  for  changing  from  one 
quantity  to  the  other  was  too  complex  to  admit  of  speed  and 
facility  in  operation.  Several  improvements  were  suggested  and 
have  since  been  successfully  incorporated  in  its  mechanism.  As  it 
stands  to-day,  the  machine  has  cost  Mr.  Willman  $2,400.  In  his 
bill  he  has  charged  the  Committee  $1,500.  During  its  construc- 
tion, the  Committee  filled  its  bottles  with  a  small  hand  machine — 
a  slow  and  expensive  operation.  The  new  machine,  can  supply 
easily  many  times  the  number  of  babies  that  are  now  being  fed. 

In  furnishing  the  depots,  the  central  problem  was  the  refrigera- 
tor. This,  as  finally  adopted,  was  a  long  box,  33^  in.  wide,  77  in. 
long,  and  25  in.  deep,  with  covers  sliding  over  each  other,  and  a 
central  ice  compartment  sufficiently  raised  from  the  bottom  to 
admit  three  of  the  smaller  crates  underneath.  The  chief  objec- 
tion to  this  box  is  the  difficulty  of  lifting  the  crates  in  and  out 
(entailing  a  great  deal  of  back-bending  and  fatigue  on  the  part 
of  the  person  handling  the  milk)  and  the  necessity  of  constantly 
throwing  the  top  open,  thus  letting  out  the  cold  air  and  reducing 
the  temperature.  The  latter  objection  is  offset  by  the  fact  that 
the  milk  comes  to  the  depot  liberally  covered  with  cracked  ice, 
and  that  in  most  cases  it  is  dispensed  shortly  after  its  arrival. 
The  temperature,  therefore,  remains  uniformly  between  45  and 
50  degrees.  Another  objection  to  the  refrigerator  is  that  owing 
to  its  great  bulk  it  takes  up  valuable  space  in  the  depot. 

The  Committee  has  under  consideration  a  refrigator  built  on 
the  plan  of  a  cabinet,  with  separate  drawers  for  each  crate,  and  a 
compartment  for  cracked  ice  to  be  used  in  keeping  the  bottles 
cool  between  the  depot  and  the  home.  Such  a  refrigerator  would 
occupy  comparatively  little  space,  would  permit  each  formula  to 
be  kept  separately,  and  would  greatly  relieve  the  person  handling 
the  bottles. 

Inasmuch  as  no  whole  milk  was  sold  in  the  depots,  the  other 
expenses  connected  with  installation  consisted  of  little  more  than 
a  table,   a   cash   drawer,   stationery,   signs   and   incidentals. 


52  A.  I.  C.  P. 

(2)     The  Business  Maintenance  of  the  Depots. 

In  order  to  determine  in  how  far  the  depots  could  be  made  self- 
supporting,  a  price  was  placed  on  the  milk  sufficient,  as  nearly  as 
could  be  estimated,  to  pay  running  expenses,  on  a  basis  of  seven 
depots  supplying  fifty  babies  each.  In  determining  this  price, 
the  salaries  of  the  nurses,  their  incidental  expenses,  the  cost  of 
printing,  statistical  and  educational  work,  were  not  included,  as  it 
was  felt  that  they  properly  belonged  to  social  or  philanthropic 
expenditures,  and  ought  not  to  be  made  a  charge  against  those 
mothers  who,  because  of  their  inability  to  breast  feed  their  in- 
fants, were  compelled  to  purchase  milk.* 

The  Committee  has  been  paying  8^4  cents  a  quart  for  its  raw 
milk,  and  has  been  selling  it  (modified)    at  the  following  rates: 

Feedings  up  to  1   ounce    1*^   cts.  a  feeding 

x/y  oz.  2      oz I   cent 

2^  "         3    "     iy2  cts. 

3        "  $l/2  "        2  cents 

6       "  8       "       2.y2  cts. 

At  first  it  was  difficult  to  obtain  these  prices.  Almost  every 
one  thought  the  rates  were  too  high.  Several  churches  and  char- 
itable organizations  refused  to  pay  more  than  "six  cents"  a 
quart,  saying  they  could  get  ordinary  store  milk  for  that  price. 
Poor  mothers  also  were  slow  in  purchasing  the  milk  and  in  many 
cases  persuasion  in  the  form  of  relief  was  necessary.  Later,  as 
the  work  of  the  depots  and  the  quality  of  the  milk  became  known, 
it  was  found  less  difficult  to  obtain  the  full  price,  even  from 
the  poorest  mothers.  In  other  words,  these  women  had  been 
educated  to  realize  the  vital  importance  of  pure  milk. 


[*  It  must  also  be  remembered  that  the  Committee  was  receiving  the 
equivalent  of  $170  monthly  from  the  Sheffield-Farms-Slawson-Decker 
Milk  Company  in  the  use  of  its  laboratory,  steam,  water,  etc. ;  that  the  de- 
oreciation  on  its  equipment,  amounting  to  $60  monthly,  and  the  interest  on 
its  invested  money,  amounting  to  $50  monthly,  was  not  included,  and  that 
it  paid  rent  for  only  the  Mott  Street  depot  and  in  that  instance  only 
half  rent,  the  remainder  being  paid  by  the  Diet  Kitchen  Association.] 


New  York  Milk  Committee  53 

During  the  month  of  August  the  receipts  from  the  sale  of  the 
milk  were  $212.44  less  than  the  expenditures — that  is  to  say, 
although  the  expenditures  were  greatly  reduced  by  the  con- 
tributions already  referred  to,  and  although  more  than  50  per 
cent,  of  the  actual  receipts  came  from  relief  agencies,  the  price 
asked  for  the  milk  failed  to  represent  the  cost  and  effort  of  pro- 
ducing a  commodity  essential  to  the  health  and  lives  of  the  babies 
using  it. 

(3)    Relief:   Its  Method  of  Dispensation. 

In  giving  relief,  the  Committee  aimed  at  just  and  efficient  dis- 
crimination. It  proposed,  by  selling  its  milk  at  a  fair  price  and 
by  cooperating  with  the  relief  department  of  the  Association  for 
Improving  the  Condition  of  the  Poor,  which  considered  it  pro 
tempore  in  the  light  of  a  retail  milk  enterprise,  to  help  those  and 
those  only  who  needed  help,  aiding  them  entirely,  partly,  or  not 
at  all,  as  circumstances  demanded.  In  order  to  do  away  with 
jealousy  and  discontent  arising  from  this  system,  the  depots  re- 
quired all  mothers  alike  to  pay  the  full  price  over  the  counter, 
and  sold  at  a  slighty  reduced  price  ($0.28  worth  for  $0.25)  the 
same  milk  tickets  which  relief  agencies,  particularly  the  Associa- 
tion for  Improving  the  Condition  of  the  Poor,  gave,  free  of  cost, 
after  a  careful  investigation.  In  this  way,  those  who  received 
assistance  were  placed  on  an  equal  footing  at  the  moment  of  pur- 
chase with  those  who  paid  the  full  price.  No  distinction  was  made 
between  tickets  and  cash,  and  every  effort  was  made  to  place  the 
responsibility  for  getting  the  price  for  the  milk  (whether  in 
tickets  or  cash  or  both)  upon  the  mother. 

The  difficulty  of  this  arrangement  was  the  necessity  of  con- 
stant visits,  and.  in  the  case  of  the  Association  for  Improving  tin- 
Condition  of  the  Poor,  the  employment  of  special  relief  visitor. 
to  keep  mothers  supplied  in  advance  with  tickets.  This  involved 
a  big  expense,  which  would  have  been  unnecessary  if  the  mothers 
had  been  permitted  to  pay  in  cash  at  the  station  the  sum  which 
the  visitor  on  her  first  visit  had  decided  they  were  able  to  pay, 
and  if  the  matron  had  thereafter  rendered  a  bill  for  the  balance 


54  A.  I.  C.  P. 

to  the  supporting  organization.    At  present  the  Committee  is  con- 
ducting its  depots  on  this  latter  plan. 

The  psychological  objections  to  a  system  where  mothers  pay 
different  amounts  for  the  same  commodity,  although  they  may 
obtain  with  respect  to  whole  milk,  which  is  sold  in  bulk  at  ordinary 
prices,  are  not  inherent  in  the  sale  of  modified  milk  where  the 
computation  of  the  price  of  varying  kinds  and  quantities  is  too  dif- 
ficult for  ignorant  mothers.  At  the  end  of  August,  144  mothers 
were  paying  the  full  price  of  the  milk ;  68  mothers  were  paying 
part  price,  and  no  mothers  received  it  free. 

(4)  Cost  of  the  Educational  Work. 

Except  for  the  salaries  of  the  nurses,  which  amount  all  told  to 
$675  monthly,  the  expenses  connected  with  the  educational  part 
of  the  Committee's  programme  have  not  been  great.  This  is  due 
largely  to  the  physicians  who  have  given  the  Committee  service, 
which,  if  it  had  paid  for,  would  have  cost  it  many  hundreds,  if 
not  thousands  of  dollars.  From  50  to  100  hours  of  time  alone  is 
contributed  by  them  weekly  in  their  thirty-six  consultations.  Their 
personal  efforts  can  never  be  repaid.  Many  of  them  devoted 
hours  of  labor,  outside  of  their  consultations,  to  constructive 
features  of  the  work,  and  at  the  sacrifice  of  their  own  interests, 
helped  the  Committee  in  its  medical,  statistical,  and  sanitary 
problems. 

A  summary  of  the  Committee's  receipts  and  expenses  from 
June  1st   to  August  31st    follows: 


New  York  Milk  Committee  55 


FINANCIAL  STATEMENT  OF  INFANTS'  MILK  DEPOTS,  JUNE 
1  TO  AUGUST  31,  1008. 
Equipment : 

Equipment  at  Central   Laboratory    $6,015.41 

Equipment    at   depots    350.02 

Painting  and  plumbing  at   depots    132.31      $6,497.74' 

Business  expenses: 

Rent  (3  months)   l/2  share  160  Mott  Street $37-50 

Printing,  stationery  and  postage   63.58 

Ice 1 18.19 

Telephone 20.45 

Cleaning,  supplies,  etc 30.54 

Milk  and  expenses  at  Central  Laboratory 2,287.07 

$2,557-33 
Less  milk  sales  at  depots   1,970.90* 

Deficit $586.43  S86.43 

Educational  and  Charitable: 

Record  charts,  printing,  etc $179.36 

Carfares    13-45 

Scales,    etc 109.26 

Salaries  of  nurses  and  helpers    (3  months)    2,148.67        2,450.74 

A  dmin  is  tra  tive : 

Salaries  at  Central  office   745-72 

Printing,  office  expenses,  etc 49T-57 

Rent  of  Central   office    33-63        1,270.92 

Total   expenditures    $10,805.83 

Contributions  received  April  1  to  August  31,  1908 2,411.10 

Total   deficit    $8,394-73 

EXPENSES  OF  MILK  DEPOTS  FOR  MONTH  OF  AUGUST.  1008. 
Total  number  of  babies  fed,  on  August  31   318 

140  paid  full  price 
68  paid  part  price 

no  received  entire  relief 
Total  number  of  bottles  sold  on  August  31  1,848 

MILK  SALES  FOR  THE  MONTH  OF  AUGUST: 

412  West  47th   Street    $81.56 

146  West  100th  Street  Ioy-30 

246  East  82nd    Street    *  59-23 

434  East    73rd    Street    ^-25 

262  East  Broadway    209-7a 

73  Cannon    Street    o    o2      *T  n™  -,« 

160  Mott  Street  l8o87      $1,029.78 

[*This  includes  $907.07  which  was  paid  by  relief  societies.  1 


56  A.  I.  C.  P. 

BUSINESS  EXPENSES  FOR  MONTH  OF  AUGUST: 

Rent    (160  Mott   Street)    y2   share    $12.50 

Ice   74.63 

Cleaning,    supplies,    etc 18.04 

Telephone     8.85 

Stationery  and  postage 8.61 

Milk  and  expenses  at  laboratory    1,119.59      $1,242.22 

Deficit  for  month  $212.44 

CASH  ACCOUNT: 

Milk  sales   in  month  of  August    $1,029.78 

Owing  from  previous  month   69.07       $1,098.85 

Cash  receipts  at  depots $458. 14 

Paid   by   relief   agencies    569.62 

Still   owing    7109      $1,098.85 


Note.  The  Committee  paid  it>i .75  per  gross  for  its  three  ounce  bottles; 
$2.45  per  gross  for  its  six  ounce  bottles,  and  $2.65  per  gross  for  its  eight 
ounce  bottles.  All  the  bottles  were  lettered  "The  New  York  Milk  Com- 
mittee." The  mould  for  the  three  ounce  bottles  cost  $13;  for  the  six  ounce 
bottles  $16;  for  the  eight  ounce  bottles  $18.  The  first  instalment  of  corks 
cost  16^  cents  per  gross  and  the  second  instalment  16  cents  per  gross.  The 
first  instalment  of  crates  cost  $2  each  and  the  second  instalment  $1.50  each. 
These  crates  are  hand  made  of  iron.  To  have  made  them  by  machinery 
would  have  necessitated  the  casting  of  a  die  costing  $2,000.  There  are 
three  sets  of  crates  and  bottles  in  use  constantly  (one  set  in  the  depots, 
one  in  delivery,  and  one  in  the  laboratory).  At  time  of  writing,  the  Com- 
mittee is  using  daily,  to  feed  375  babies,  900  three  ounce  bottles,  3,600  six 
ounce  bottles  and  2,100  eight  ounce  bottles;  45  three  ounce  crates,  180  six 
ounce  crates  and  90  eight  ounce  crates. 

The  cost  of  the  other  articles  of  equipment  was  as  follows :  one  sterilizer 
$325;  two  copper  boilers  $125  each;  one  separator  $86;  one  bottle-washer 
$550;  one  bottle-filler  $1,500;  40  wire  covers  $24;  two  wire  baskets  $7;  one 
hand  bottle-filler  $7;  scales,  crocks,  pails,  etc.  $25;  lumber,  fittings  and 
labor  $425. 

The  Committee  uses  Cereo  Company's  barley,  sterilized,  standardized 
and  put  up  in  one  pound  packages  costing  12  cents  each.  Experience 
seems  to  indicate  that  barley  in  the  barrel  is  likely  to  spoil.  Milk  sugar 
costing  12  cents  a  pound  in  200  lb.  barrels  was  used  at  first.  This  has 
been  changed  to  cane  sugar  on  account  of  the  expense. 


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New  York  Milk  Committee  57 

THE  WORK  OF  THE  NURSES  NOT  CONNECTED  WITH 
MILK  DEPOTS. 

In  order  to  compare  the  work  of  the  depot  nurses  with  nurses 
not  connected  with  depots  (as  provided  in  Experiment  No.  2), 
three  nurses  were  originally  engaged  to  do  independent  field  work. 
At  the  end  of  two  weeks,  one  of  these  nurses  decided  that  she 
was  unequal  to  the  task,  and  her  conclusion  seemed  to  be  borne 
out  by  the  fact  that  at  the  end  of  two  weeks  of  effort  in  a  district 
whose  population  for  seven  blocks  was  upwards  of  25,000  peo- 
ple,* not  a  single  mother  was  present  at  her  consultation.  This 
incident  is  referred  to  because  it  illustrates  the  difficulty  of  or- 
ganizing consultations  without  the  attraction  of  milk. 

At  this  time,  too,  the  hot  weather  came  on,  and  the  depot 
nurses,  who  were  working  seven  days  a  week,  and  putting  a  great 
deal  of  themselves  into  the  work,  began  to  find  themselves  very 
much  run  down.  The  Committee  therefore  decided  to  use  the 
successor  to  the  unsuccessful  nurse  as  a  substitute  to  relieve  the 
depot  nurses  one  day  a  week,  leaving  two  nurses  for  the  purely 
educational  work.  These  two  nurses  had  their  headquarters,  and 
conducted  consultations  at  the  following  places : 

248  E.    105th  Street,  Jewish  and  Italian  district,   room  in 

Union  Settlement,  rent  free. 
173  W.  63rd  Street,  Negro  district,  San  Juan  Hill,  room  in 
St.  Cyprian's  Chapel,  rent  free. 

The  work  of  these  nurses  has  been  similar  to  that  of  the  nurses 
in  the  depots,  except  that  the  doctors  have  taught  the  mothers 
how  to  prepare  their  own  formulae  from  milk  which  has  been 
purchased  from  the  ordinary  milk  dealer,  and  that  the  nurses 
have  thus  been  able  to  devote  to  actual  visiting  the  time  and 
effort  which  the  depot  nurses  have  been  compelled  to  give  to 
dispensing  milk  and  rendering  accounts.  Many  of  the  mothers 
who  came  under  the  care  of  these  nurses  were  referred  by  them 
to  the  depots  of  the  Diet  Kitchen  Association,  located  in  205 
West   62nd    Street   and    1,636   Lexington    Avenue,    where    they 


[*  The  Jewish  district  on  the  lower  East  Side  bounded  by  East  Houston 
Street,  Avenue  A,  East  Fourth  Street,  and  Avenue  D.] 


58  A.  I.  C.  P. 

were  provided  free  with  certified  milk.  At  the  advice  of  the 
doctors,  both  the  certified  milk  and  the  ordinary  store  milk  was 
in  a  majority  of  cases  "boiled"  in  the  home. 

Both  outside  nurses  experienced  difficulty  in  getting  ignorant 
mothers  to  attend  their  classes  regularly.  They  found  that  they 
had  no  "hold"  upon  these  mothers,  and  that  the  easiest,  and  in 
some  cases  the  only,  way  to  secure  their  attendance  was  to  give 
them  free  tickets  for  milk  or  fresh  air  excursions,  provided  for 
distribution  by  various  philanthropic  agencies.  Both  nurses 
steadily  felt  that  they  could  reach  more  of  the  mothers  who  real- 
ly needed  assistance  if  they  could  connect  themselves  in  some 
way  with  the  dispensation  of  milk.  They  wished  the  whole  milk 
as  well  as  the  modified  milk,  however,  believing  that,  in  many 
instances,  the  mothers  could  prepare  their  own  formulas  from 
the  whole  milk  at  home,  without  injury  to  their  infants  and  with 
great  economy  to  the  family  budget.  Subsequently,  applications 
for  milk  depots  were  received  from  both  the  Union  Settlement 
and  the  workers  interested  in  St.  Cyprian's  Chapel,  where  these 
nurses  organized  their  consultations. 


New  York  Milk  Committee  59 

A  STUDY  OF  THE  RESULTS  OBTAINED  BY  THE  NURSES 

IN   THE   MILK   DEPOTS   AND    BY   THE    NURSES    NOT 

CONNECTED  WITH  MILK  DEPOTS. 

In  comparing  statistically  the  work  of  the  nurses  in  the  depots 
and  those  outside,  it  is  necessary  to  bear  in  mind  the  following 
facts : 

i.  The  "outside"  nurses  gave  all  their  time  to  instructional  and 
"follow-up"  work. 

2.  The  depot  nurses  gave  a  minimum  of  their  time  to  instruc- 
tional and  follow-up  work,  being  compelled  to  devote  the  larger 
share  to  dispensing  milk,  bookkeeping,  and  details  of  business 
and  depot  management.  This  work  was  especially  exacting  be- 
cause of  the  novelty  of  the  undertaking  and  the  nurses'  lack  of 
business  training,  which  often  resulted  in  unnecessary  confusion 
and  labor. 

3.  The  mothers  who  came  regularly  to  the  consultations  for  in- 
structions only  were,  as  a  rule,  more  intelligent  than  those  who 
were  drawn  to  the  depots  and  held  there  primarily  by  the  milk. 
Instruction  consequently  was  more  effectually  carried  out,  and 
the  nurse  met  with  better  cooperation  in  the  homes. 

4.  The  babies  looked  after  by  the  "outside"  nurses,  included 
weaned  babies  and  breast-fed  babies.  The  "risks"  run  in  these 
cases  was  not  so  great  as  that  of  the  "bottle"  babies,  fed  by  the 
depot  nurses.* 

In  reviewing  statistically  the  work  of  these  two  groups 
of  nurses,  the  difficulty,  anticipated  by  some  at  the  start,  that  the 
estimates  of  the  physical  condition  in  which  the  babies  were 
brought  to  the  depots  would  vary  with  different  physicians,  thus 
depreciating  the  value  of  conclusions  concerning  their  subsequent 


[*  In  the  consultations  connected  with  Union  Settlement,  39  out  of  108 
babies  received  up  to  August  31,  or  36%,  were  breast-fed;  in  the  consulta- 
tions connected  with  St.  Cyprian's  Chapel  49  out  of  97  babies  received  up 
to  August  31,  or  50%,  were  breast-fed.] 


60  A.  I.  C.  P. 

condition,  was  substantiated  in  a  few  cases.  The  general  results, 
however,  were  encouraging  and  showed  the  value  of  the  Commit- 
tee's record  charts  for  statistical  purposes.  Of  seven  babies  who 
died  at  the  depot  in  the  Yorkville  dispensary,  the  estimates  were 
as  follows : 

Case  I      —  15%   (bad) 

Case  II    —  45%   (poor) 

Case  III  —  35%   (poor) 

Case  IV  —  20%   (bad) 

Case  V    —  10%    (moribund) 

Case  VI  —  20%   (bad) 

Case  VII — no  estimate  (took  milk  3  days). 
In  the  East  73rd  Street  depot,  on  the  other  hand,  of  four  babies 
who  died,  the  estimates  were : 

Case  I      —  75%   (good) 

Case  II    —  50%   (poor) 

Case  III  —  75%   (good) 

Case  IV  —  60%  (fair) 
Here,  obviously,  one  of  two  things  happened.  Either  the 
physicians  overestimated  the  condition  of  the  babies,  or  the  milk 
itself  was  at  fault.  Looking  into  the  two  cases  estimated  at  75, 
we  find  that  the  first  died  of  pneumonia,  after  an  attack  of  bron- 
chitis (its  mother  had  pulmonary  tuberculosis),  while  the  second, 
whose  mother's  intelligence  was  estimated  at  85  and  whose  home 
life  at  81,  died  of  gastro-enteritis,  after  attending  two  classes 
and  getting  the  milk  thirteen  days.  The  history  of  the  first  case 
lifts  responsibility  from  the  milk  and  the  depots ;  that  of  the 
second  points  to  the  milk  as  the  causative  factor.* 


[*  Where  mothers  are  ignorant,  it  is  exceedingly  difficult  to  fix  the 
depot's  responsibility  for  the  effect  of  milk  which  it  sells  on  babies  using 
it.  One  woman,  for  instance,  complained  that  the  milk  was  "No  good"; 
her  baby  had  diarrhoea.  The  nurse  called,  and  found  currant  seeds  in  the 
stools.  "Yes,  she  had  fed  the  baby  currant  cake  and  a  little  watermelon 
and  tea,  too,"  the  mother  said.  Another  complained  because  a  cockroach 
had  been  found  in  the  bottle.  On  calling,  the  nurse  noticed  the  nipple  on 
the  floor  in  the  corner.  Stooping  to  pick  it  up,  several  lively  fellows 
rattled  up  the  wall.  These  cases  show  how  many  other  factors  enter  into 
the  problem  and  of  how  little  avail  the  best  milk  is  when  the  mother 
lacks  intelligence.] 


New  York  Milk  Committee  di 

When  a  condensed  milk  baby  rated  at  10  (or  moribund)  is 
brought  to  the  depot  as  a  last  resort,  its  death  from  gastroenter- 
itis, after  attending  one  consultation  and  getting  the  milk  one 
day,  is  not  remarkable. 

In  the  week  ending  August  31st,  three  hundred  and  nineteen 
babies  attended  consultations  connected  with  the  milk  depots, 
and  one  hundred  and  thirty-seven  attended  consultations  given 
by  the  outside  nurses.  Following  is  a  statement  of  the  condi- 
tion in  which  these  babies  were  found  at  their  last  weighing. 

Babies  who  were  weighed  at  consultation,  week  ending  Aug.  31, 
1908: 


Pasteurized 

Raw 

Both 

Independent 

Milk 

Milk 

Kinds 

Consultations 

Gaining 

127      81.4% 

120      73.6% 

247    774% 

95     69.4% 

Stationary 

8      5-1% 

23      14.1% 

31       97% 

19     13-8% 

Lost 

21     13.5% 

20       12.39? 

41     12.9% 

23   16.8% 

Total 

156         Total 

163       Total 

319          Total 

137 

From  the  above  figures,  it  appears  that  77.4%  of  the  depot 
babies  were  gaining  at  the  end  of  the  summer  against  69.4% 
of  the  babies  who  came  to  consultations  not  connected  with  milk 
depots;  that  9.7%  were  remaining  stationary  as  against  13.8%, 
and  that  12.9%  had  lost  as  against  16.8% — this,  in  spite  of  the 
fact  that  many  of  the  babies  who  came  to  consultations  not  con- 
nected with  milk  depots,  were  getting  certified  milk  from  the  Diet 
Kitchen  Association,  and  that  other  factors,  mentioned  at  the  be- 
ginning of  this  section,  appeared  to  favor  the  physical  progress  of 
these  infants. 

The  mortality  in  the  depots  and  independent  consultations  tells 
a  different  story — four  deaths  having  occurred  in  the  independ- 
ent consultations  as  against  thirty-three  in  the  depots.  Tn  how 
far  this  difference  was  due  to  the  greater  personal  attention  of  the 
independent  nurses,  to  the  greater  number  of  breast-fed  babies 
under  their  supervision,  to  the  excellent  character  of  the  Diet 
Kitchen  milk  which  many  of  the  others  received,  or  to  the  fact 
that  the  milk  depots  attracted  many  infants  already  on  the  point 
of  death,  is  a  matter  of  opinion.     It  is  not  improbable,  judging 


62  A.  I.  C.  P. 

from  the  relative  physical  improvement  of  the  infants  cared  for 
by  both  kinds  of  nurses  at  the  end  of  August  that  these  factors 
had  considerable  weight;  but  this  does  not  detract  from  the  good 
showing  of  the  independent  nurses,  whose  work,  as  will  be  shown 
later  was  conducted  at  a  great  economy  over  that  of  the  depot 
nurses. 

Of  the  37  deaths  which  occurred  among  the  babies  brought  to 
the  depots  and  to  the  independent  consultations,  the  organization 
of  physicians  working  in  connection  with  the  depots  has  esti- 
mated that  the  Committee  was  apparently  responsible  in  two 
cases,  possibly  responsible  in  one  case  and  evidently  not  respon- 
sible in  thirty-four  cases. 

Apart  from  figures,  the  opinion  of  those  who  have  acquainted 
themselves  with  the  Committee's  work  has  been  most  gratifying. 
Dr.  Pisek  said  recently  that  he  would  rather  keep  a  baby  in  the 
city  in  hot  weather,  on  the  Committee's  milk,  with  the  mother 
attending  the  consultations,  than  send  it,  with  the  usual  change  of 
diet,  to  any  hospital  or  seaside  resort ;  and  the  physicians  working 
on  the  East  Side  have  often  said  that  an  extension  of  the  work 
as  carried  on  now  in  the  Committee's  depots  in  Cannon  Street  and 
East  Broadway  would  be  the  biggest  blessing  ever  conferred  upon 
the  poor  people  in  that  quarter  of  the  city.  With  all  this,  how- 
ever, there  are  many  things  to  criticise  and  the  Committee  not  only 
criticises  itself,  but  invites  criticism,  to  the  end  that  it  may  attain 
the  ideal  toward  which  it  is  imperfectly  striving. 

One  of  the  interesting  facts  brought  out  by  the  summer's  work 
is  the  results  that  have  been  accomplished  with  a  minimum  of 
visiting,  emphasizing  the  value  of  the  group  or  class  method  of 
education.  In  August,  one  of  the  depot  nurses  made  only  twelve 
visits.  Yet  this  nurse  was  one  of  the  Committee's  hardest  and 
most  effective  workers.  In  her  case,  as  with  each  of  the  others, 
much  corrective,  preventive  and  instructional  work  was  done  in  the 
depot,  and  especially  at  the  time  of  the  daily  distribution  of  milk, 
The  opportunity  of  seeing  all  the  mothers  each  morning  was  of 
great  assistance  in  following  each  individual  case,  and  of  demon- 
strating the  old  adage,  "an  ounce  of  prevention  is  worth  a  pound 
of  cure." 


NO.     1 


1    43| 

2 
3 

4 

5  |7; 

6 

7 


MILK   DE- 
POTS. 


9 

10  |2J 
11 
12 
13 
14 
15 
16 
17 
18 


fcSTEURIZED 
ILK  DEPOTS,  i 


1    1| 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
I    15 


ONSULTATIONS 
OT  CONNECTED 
riTH  MILK  DE- 
OTS. 


TABLE  OF 

TOATHS  OF  INFANTS  AT  RAW  AND  PASTEURIZED  MILK 

DEPOTS  AND  AT 

CONSULTATIONS  NOT  CONNECTED  WITH 

MILK  DEPOTS,  JUNE  18— AUGUST  30,  1908. 

KO. 

MILK  DEPOT. 

AL1TY. 

JR0UGHT 

TO 

DEPOT. 

WEEKS. 

DISEASE 

WHEN  BROUGHT  TO 

DEPOT. 

EST.    COND. 

WHEN 

BROUGHT 

TO  DEPOT. 

EST.  IN- 
TELLIGENCE 
OF 
MOTHER. 

EST.  HOME 
LIFE. 

FEEDING. 
BREAST, 
PARTLY 
BREAST. 
BOTTLE. 

MOTHER  ABLE  TO 
BREAST-FEED. 

BREAST-FEEDING 
PREVENTED  BY 

BOTTLE 
FEEDING 
BEGAN 
AFTER 
BIRTH. 

EMPLOY- 
MENT 
BEFORE 

.  ..it.fINF 
MENT. 

NO.  OF 

CONSULTA- 
TIONS AT- 
TENDED. 

DAYS   ELAPS- 
ING BET.  FIRST 
AND  LAST  DAY 
MOTHER    RE- 
CEIVED MILK. 

DAYS 

MOTHER 

ACTUALLY 

RECEIVED 

MILK. 

INTER-CURRENT  ILLNESSES. 

CAUSE  OF  DEATH. 

REMARKS. 

ESTIMATE* 

OF 
COMTTEE'S 
RESPONSI- 
BILITY. 

. 

(34  E.  73d  St. 

Sohemiah 

- 

75 

1 

■ 

Bottle 

Not  at  all 

Disease 

At  once 

Light 

6 

75 

5 

Vomiting,    diarrhoea,    bron- 
chitis 

Conjunctivitis,  burns,  maras- 
mus, vomiting  &  diarrhoea 

Pneumonia 

G  astro-enteritis 

Mother  has  pulmonary  tuberculosis 

Child  just  brought  home  from  Post  Grad.  Hospital 

No 
No 

3 

" 
73  Cannon  St. 

3ohemian 

* 

I 

85 

81 

Partly 
Bottle 

Partly 
Not  at  all 

Partly 

Lack  of  milk 
No  milk 
^ack  of  milk 

At  once 

Light 
Severe 
Light 

26 

Diarrhoea 
diarrhoea 

Gastro-enteritis 
Unknown 

Child  taken  to  private  physician.    Mother  advised  to  breast-feed  entirely 

Child  died  suddenly.    Mother  a  cigarette  maker 

)ne  of  twins— mother  nursed  the  other— left  depot  for  2  days  and  fed  baby  on  milk  from  roof-garden: 
baby  contracted  severe  diarrhcea  from  which  it  did  not  recover. 

Apparently 
No 

No 

Wholly 

Child  ref.  breast 

Light 

Pneumonia 

Pneumonia 

Child  brought  to  depot  very  sick.    Taken  to  Junior  Sea  Breeze  July  17.    Died  July  19 

No 

" 

" 

Hungarian 

17 

Severe  diarrhoea 

60 

75 

40 

Partly 

Partly 

jack  of  milk 

At  once 

Light 

4 

Diarrhcea 

No 

Hungarian 

65 

80 

99 

Partly 

Partly 

Child  ref.  breast 

2wks 

Light 

25 

25 

Convulsions 

Convulsions 

Child  fell  out  of  carriage  week  previous  to  death 

No 

8 

11 

70 

90 

75 

Bottle 

Not  at  all 

No  milk 

2wks 

Light 

8 

8 

Diarrhcea 

n  good  condition  when  came,  but  father  fed  it  blackberry  brandy  and  currants 

No 

RAW  MILK   DE- 

to 

246  E.  82d  St 

German 

49 

8 

50 

50 

Bottle 

Not  at  all 

Disease 

4mos 

Severe 

4 

2 

Gastro-enteritis 

Very  weak  when  brought  to  depot 

No 

n 

jerman 

15 

Green  stools.   Ma- 

15 

50 

35 

Bottle 

Not  at  all 

No  milk 

2  days 

24 

Green  stools,  marasmus 

Marasmus 

Sent  to  hospital  Aug  10,  died  Aug.  12 

No 

12 

2. 

rasmus 

45 

50 

40 

Bottle 
Bottle 

Not  at  all 

Child  ref.  breast 

At  once 

Light 

56 

Summer   complaint,    gastro- 

Gastro-enteritis 

One  of  the  twins,  both  in  bad  condition— mother  refused  persistently    to  obey  instructions  and  child 

never  received  proper  attention. 

Mother  said  child  refused  to  drink  depot  milk  1 

Possibly 
No 

Hungarian 

VTwins.    Died  in  hospital 

Hungarian 

n 

20 

45 

Bottle 

Not  at  all 

So  milk 

lwk 

Severe 

1 

1 

Mother  said  child  refused  to  drink  depot  milk  ) 

No 

IS 

6 

Green  stools 

10 

50 

80 

Bottle 

Not  at  all 

Disease 

At  once 

7 

6 

Gastro-enteritis 

One  of  twins.    Both  sent  to  hospital  and  died  same  day.    Had  been  fed  on  condensed  milk 

No 

16 

American 

42 

Green  stools 

20 

60 

40 

BotUe 

Not  at  aU 

At  once 

Light 

* 

2 

Gastro-enteritis 

No 

IS 

146  W.  100th  St. 

talian 

90 

Pneumonia 

90 

60 

85 

Bottle 

Partly 

Lack  of  milk 

Light 

Light 

34 

Green  stools  after  coming  to 

Entero  colitis 
Pneumonia 

Formula  ordered  by  Vanderbilt  Clinic,  where  child  was  being  treated  for  pneumonia 

Apparently 
No 

; 

160  Mott    St. 

Italian 

» 

Diarrhoea 

" 

l 

50 

Bottle 
Partly 

Not  at  all 
Not  at  all 
Not  at  all 

No  milk 
No  milk 

At  once 

2wks 

Light 
Light 
Light 

Light 

9 

8 

Diarrhoea 

Gastro-enteritis 

Unknown 
Unknown 
Diarrhcea 

Treated  by  private  physician,  died  several  weeks  after  leaving  depot 

Treated  by  private  physician,  died  three  weeks  after  leaving  depot 
Died  23  days  after  leaving  depot 
Treated  by  private  physician 

No 

No 
No 
No 

6 

»2E„,B.«.y 

Russian 

« 

45 

2S 

60 

Bottle 
Bottle 

Not  at  all 
Not  at  all 

Pregnancy 

6mos 

Severe 
Light 

3 

9 

Diarrhoea 
Mastoid  operation 

Diarrhoea 

Went  to  Gouverneur  Hosp.  Aug,  15,  died  Aug.  18 

No 
No 

PASTEURIZED 
MILK  DEPOTS. 

8 

Russian 

18 

40 

40 

50 

Bottle 

Dr.  advised  not 
Mother    ill-nour- 

At  once 

Light 

13 

13 

Pneumonia 

Pneumonia 

Died  at  Babies'  Hosp. 

No 

1 

Hungariar 

31 

Eczema,      moras 

45 

60 

50 

Bottle 

At  once 

Light 

24 

IS 

Marasmus 

No 

10 

American 

70 

50 

40 

40 

Partly 

Partly 

Weakness 

3mos 

Light 

8 

s 

Marasmus,  rickets 

Marasmus   and 

Mother  did  not  come  for  milk  until  24  days  after  doctor  prescribed  it 

No 

l 

412  W.  47th  St 

American 

16 

Emaciated,  vomit 

I 

I 

57 

Bottle 
Bottle 
Bottle 

Not  at  aU 

Rheumatism 

E 

Severe 
Light 
Light 

] 

} 

Vomiting 
Diarrhcea,  vomiting 

Diarrhoea 

Very  sick  at  all  times.     Bowels  green  and  curds.     Died  in  convulsions 
Mother  gave  baby  home  remedies  and  fed  it  raw  miUc 
Mother  gave  baby  brandy 

No 
No 
No 

14 

Irish 

17 

70 

75 

66 

BotUe 

Not  at  all 

Mastitis 

7  days 

Light 

28 

28 

Diarrhoea 

Diarrhcea 

Mother  took  baby  to  country  July  16,  apparently  well.    Returned  with  diarrhcea  July  23.    Taken  to 

No 

jrivate  physician.     Did  not  return  to  depot.     Died  July  27 

15 

Irish 

61 

Pneumonia 

27 

40 

29 

Bottle 

Not  at  all 

Pregnancy 

lyear 

Light 

10 

10 

Pneumonia 

"hild  died  of  neglect.    Mother  a  drunkard 

No 

CONSULTATION 

STATION. 

1 

248  E.  105th  St 

American 

22 

Malnutrition 

30 

65 

50 

Bottle 

Not  at  all 

No  milk 

lmo 

Light 

Gastro-enteritis 

After  attending  2  consultations  was  sent  to  seaside.     Returned  in  bad  condition  and  did  not  improve 

No 

NOT  CONNECTED 
WITH  MILK  DE- 
POTS. 

2 

173  W.  63d  St. 

English 

9 

condition 

25 

50 

80 

Bottle 

Not  at  all 

Disease 

lwk 

Light 

Diarrhcea 

Treated  by  private  physician.    Died  several  weeks  after  leaving  consultation 

No 

3 

American 

17 

30 

50 

47 

Bottle 

Not  at  all 

No  milk 

lwk 

Light 

2 

Pneumonia 

Treated  by  private  physician.    Died  several  weeks  after  leaving  consultation 

No 

I     4 

English 

22        IBteSS™ 

IS 

40 

63 

Bottle 

Not  at  all 

No  milk 

2wks 

Light 

1 

Diarrhoea 

Treated  by  private  physician.    Died  several  weeks  after  leaving  consultation 

No 

Summary— deaths  u 


—Estimate  of  Committee 


approved  by  the  Association  of  Physicians  ol  the  New  York  City  Milk  Depots, 


New  York  Milk  Committee  63 

In  like  manner,  the  nurse  at  East  105th  Street,  who  was  not 
connected  with  a  milk  depot,  and  who  had  only  one  death  to  her 
credit  throughout  the  summer  (that  of  a  moribund  incubator 
baby),  made  in  August  only  eight-eight  visits,  or  an  average  of 
four  a  day.  This  nurse  was  a  Normal  graduate  (one  of  the  few 
"teaching"  nurses  in  the  State),  and  had  had  considerable  exper- 
ience as  an  instructor  in  domestic  science.  Her  work  is  inter- 
esting from  an  educational  standpoint,  as  it  shows  the  results  of 
quality  versus  quantity.  Frequently  her  home  visits  lasted  as 
long  as  two  hours.  She  aimed,  with  all  the  others,  to  do  thorough 
work,  believing  that  one  mother  won  was  better  than  a  hun- 
dred vaguely  and  indefinitely  impressed.  This  is  the  spirit  the 
Committee  has  tried  to  inspire  in  all  its  nurses,  and  which  it 
believes  is  largely  responsible  for  the  personal  interest  and  effort 
displayed  by  each  of  them.  All  of  the  nurses  overworked.  Those 
employed  in  depots  worked  seven  days  a  week  throughout  a 
great  part  of  the  summer.  Some  began  as  early  as  seven  in  the 
morning  and  did  not  finish  until  seven  or  eight  at  night.  They 
did  not  consider  themselves,  but  worked  because  they  were  inter- 
ested in  their  work.  This  is  a  spirit  to  admire,  but  social  agencies 
must  take  care,  lest  in  saving  infants,  they  kill  a  number  of  women 
who  are  useful  to  them   and  to  the  community  as  well. 

THE  EXPERIMENTAL  PROGRAM— FACTS  SHOWN  BY  THE 

SUMMER'S   WORK. 
Experiment   No.    1. — What  are  the   comparative   results 

OBTAINED   BY   THE   CONTINUED   USE   OF   PASTEURIZED   AND   OF   RAW 
MILK? 

Of  156  babies  attending  consultations  in  the  pasteurized  milk 
depots,  the  week  ending  August  31st,  the  condition  of  81.4% 
was  improving  as  opposed  to  73.6%  in  the  raw  milk  depots.  On 
the  other  hand,  only  12.3%  of  the  raw  milk  babies  actually 
lost  against  13.5%  of  the  pasteurized  milk  babies.  The  dif- 
ference is  accounted  for  in  the  number  of  babies  whose  condition 
remained  stationary,  this  number  being  larger  in  the  raw  milk- 
depots  than  in  the  pasteurized  milk  depots.     The  total  number  of 


64  .A.  I.  C.  P. 

babies  whose  condition  was  either  stationary  or  improving  in  the 
raw  milk  depots  was  87.7%,  against  86.5%  in  the  pasteurized 
milk  depots.  Of  the  babies  who  died,  the  two  whose  deaths 
apparently  were  due  to  the  milk  were  fed  on  raw  milk,  as  was 
also  the  one  whose  death  was  possibly  due  to  the  milk.* 

Because  of  the  brevity  of  the  period  which  they  cover,  these 
figures  have  little  statistical  value.  Actually,  however,  it  was  the 
experience  of  the  physicians  that  the  babies  fed  on  raw  milk 
were  more  apt  to  be  upset  than  the  babies  fed  on  pasteurized  milk  ; 
and  it  was  the  custom,  among  certain  of  them,  to  order  the  mother 
to  pasteurize  the  raw  milk  in  the  feeding  bottles,  if  by  chance 
it  did  not  agree  with  the  baby.  The  fact  that  this  was  deemed 
necessary,  as  well  as  the  good  showing  made  by  the  two  nurses 
not  connected  with  infants'  milk  depots,  who  instructed  their 
mothers  to  bring  their  milk  to  the  boiling  point,  substantiates  the 
opinion  of  those  who  have  worked  upon  this  problem  that  raw 
milk,  however  excellent  may  be  its  quality  and  however  care- 
fully it  may  be  prepared,  is  less  desirable  for  infant  feeding  dur- 
ing the  summertime  than  pasteurized  milk.  The  nutritive  value 
of  the  two  kinds  of  milk  is  a  question  which  can  only  be  decided 
after  a  period  of  long  and  wide  observation,  such  as  the  Com- 
mittee has  undertaken.  Given  a  certified  or  guaranteed  milk, 
properly  modified,  refrigerated  and  safeguarded  in  every  way, 
the  question  of  pasteurizing  it  or  using  it  in  raw  state  is  of  minor 
consideration  compared  to  the  instruction  of  the  mother  and 
the  care  which  she  gives  her  infant.  But  until  the  system  of 
handling  even  this  certified  or  guaranteed  milk  has  been  reduced 
to  the  highest  state  of  perfection,  from  the  farm  to  the  consumer. 


[*  Among  the  mothers  who  used  raw  milk,  the  home  refrigeration  was 
poorer  than  among  those  who  used  the  pasteurized  milk.  This  is  shown 
in  the  table  on  page  27.  The  one  death  for  which  the  depots  possibly 
were  responsible  occurred  at  246  East  82d  Street,  where  50%  of  the 
mothers  had  no  refrigerators.  One  of  the  deaths  for  which  the  depots 
apparently  were  responsible,  was  at  146  West  100th  Street,  where  25%  of 
the  mothers  had  no  refrigerators,  and  one  was  at  434  East  73rd  Street, 
where  80%  of  the  mothers  had  no  refrigerators.  1 


New  York  Milk  Committee  65 

the  milk,  for  infant  feeding,  should  be  pasteurized.  Given  ordin- 
ary store  milk,  modified  by  the  mother,  the  question,  in  the  present 
state  of  the  supply,  admits  of  only  one  answer — that  milk  should 
be  pasteurized.* 

Experiment  No.    2. — Which  is  the  more  economical  and 

SATISFACTORY    METHOD    OF    SAVING    INFANTS'    LIVES THE    PURELY 

EDUCATIONAL  PROGRAM  CARRIED  ON  IN  CONNECTION  WITH  THE 
ORDINARY  MILK  SUPPLY,  OR  THE  SALE  OF  MODIFIED  MILK  DIS- 
PENSED  BY    NURSES   WHO   ALSO  DO   INSTRUCTIONAL    WORK? 

The  work  of  the  past  three  months  demonstrates  that  even  in 
the  present  condition  of  the  general  milk  supply,  infant  mortal- 
ity may  be  reduced  through  the  holding  of  classes  or  consulta- 
tions in  which  mothers  are  instructed  how  to  feed  and  care  for 
their  babies,  by  physicians,  assisted  by  nurses,  who  "follow  up" 
this  instruction  into  the  homes. 

The  significance  of  this  is,  briefly,  that  with  no  expenditure 
whatever  for  a  laboratory  and  equipment  for  modifying  and  dis- 
tributing milk,  any  city,  settlement  or  philanthropy  may  defi- 
nitely save  infants'  lives  by  obtaining  the  services  of  physicians 
assisted  by  trained  field  nurses. 

But  while  independent  nurses  can  obtain  results,  these  results 
would  be  multiplied  and  enhanced,  if,  still  retaining  their  free- 
dom from  business  details,  the  nurses  could  have  the  support  of 
infants'  milk  depots.     The  greatest  weakness  of  the  Milk  Com- 


*  At  a  meeting  of  the  Executive  Committee  of  the  Milk  Committee 
held  October  14th,  the  following  statement  of  the  Committee's  attitude 
toward  pasteurized  milk  was  formulated  and  approved : 

The  Committee  approves  of  the  pasteurization  of  all  milk  which  has  not 
been  produced  under  sanitary  conditions  which  has  not  come  from  tuber- 
culin tested  cattle  and  cattle  otherwise  free  from  disease  and  which  can- 
not be  supplied  to  the  consumer  with  a  sufficiently  low  bacterial  content  to 
offer  safety  from  milk  borne  infection.  The  Committee  approves  of  the 
pasteurization  of  milk  when  modified  for  infants'  use  in  the  home. 

The  Committee  approves  of  all  measures,  individual,  state  or  municipal, 
which  will  lead  to  the  institution  of  sanitary  conditions  on  dairy  farms. 
(This  conviction  has  on  two  occasions,  led  it  to  oppose  measures  directed 
towards  the  establishment  of  compulsory  pasteurization  of  milk  by  city 
or  state  authorities,  on  the  ground  that  such  measures  would  put  the  pro- 
ducer of  dirty  milk  on  an  equal  footing  with  the  producer  of  clean  milk, 
and  thereby  postpone  the  institution  of  the  desired  sanitary  reforms.) 


66  A.  I.  C.  P. 

mittee's  outside  nurses  during  the  past  summer  (apart  from  the 
handicap  of  poor  milk)  lay  in  their  inability  to  secure  a  firm 
hold  upon  mothers  for  purely  instructional  work.  Their  greatest 
strength  lay  in  their  freedom  to  visit  and  "follow  up." 

The  greatest  weakness  of  the  depot  nurses  lay  in  the  restraint 
(entirely  removable)  which  milk  distribution  and  business  de- 
tails imposed  upon  them ;  and  their  greatest  strength  (apart  from 
the  value  of  the  pure  milk  which  they  sold),  lay  in  the  bond 
which  the  sale  of  that  milk  constituted  between  them  and  those 
whom  they  were  trying  to  educate. 

The  answer  to  the  Committee's  experiment,  therefore,  is  found 
neither  in  one  system  nor  in  the  other,  but  in  the  combination  of 
the  two;  that  is  to  say,  in  the  connection  of  free  nurses  with 
infants'  milk  depots. 

Whole  milk  should  be  sold  at  these  depots  in  conjunction  with 
modified  milk  for  the  following  reasons : 

i.  Because,  especially  in  communities  where  ignorant  mothers 
look  upon  bottled  milk  as  possessing  great  efficacy,  the  exclusive 
sale  of  modified  milk  places  undue  emphasis  on  hand  feeding,  and, 
as  the  Committee's  doctors  have  found  in  many  instances,  actually 
discourages  feeding  at  the  breast. 

2.  Because  the  exclusive  sale  of  modified  milk  deprives  the 
fairly  intelligent  mother  of  an  opportunity  to  exercise  her  intelli  • 
gence  in  modifying  her  own  milk,  and  thus  is  a  step  backward  in 
the  educational  program. 

3.  Because  where  the  mother  is  intelligent  and  carefully  fol- 
lows the  physician's  instructions,  she  actually  can  give  the  baby  a 
food  better,  because  more  elastically  fitted  to  its  needs. 

4.  Because  modified  milk  costs  more  than  the  average  tene- 
ment mother  can  pay. 

5.  Because  giving  this  milk  (either  through  reduced  prices 
or  actual  relief)  to  mothers  who  are  able  to  modify  whole  milk 
imposes  on  philanthropy  an  expenditure  which  the  Committee  be- 
lieves might  better  be  applied  to  an  educational  program. 


New  York  Milk  Committee  67 

During  the  month  of  August,  the  Milk  Committee  supplied 
modified  milk  gratuitously  to  one  hundred  infants.  The  average 
amount  of  milk  consumed  by  each  baby  daily  was  32^  ounces. 
The  actual  cost  of  producing,  modifying,  and  delivering  this 
milk,  not  including  rent  of  depots,  help  in  depots,  refrigeration, 
light,  incidentals  in  depots  and  general  administration,  was  $.004 
an  ounce  or  13  cents  daily  for  each  infant.  Had  the  items  men- 
tioned been  added,  the  actual  cost,  apart  from  the  nurses'  salaries, 
would  have  been  very  nearly  $.005  an  ounce  or  i6j4  cents  daily 
for  each  infant.  * 

For  the  one  hundred  infants  fed  gratuitously  in  August,  the 
Committee,  through  its  business  losses,  and  the  New  York  Associ- 
ation for  Improving  the  Condition  of  the  Poor,  through  its  relief, 
expended  actually  $503.75.  From  this  must  be  deducted  the  sum 
which  it  would  have  paid  for  whole  milk  had  it  been  merely  hv- 
structing  the  mothers.  The  amount  of  whole  milk  consumed 
daily  by  each  infant  fed  by  the  Committee  in  August  was  18  4-10 
ounces  or  a  little  more  than  one  pint.  At  the  rate  of  15  cents  a 
quart  for  certified  milk,  this  one  pint  would  have  cost  7^  cents 
daily  or  $232.50  monthly  for  one  hundred  infants,  a  saving 
of  $271.25  over  the  cost  of  modified  milk. 

At  the  rate  of  10  cents  a  quart,  it  would  have  cost  5  cents 
daily  or  $155  monthly,  for  one  hundred  infants,  a  saving  of 
$348.75  over  the  cost  of  modified  milk. 

At  the  rate  of  7  cents  a  quart,  it  would  have  cost  3^  cents  daily- 
or  $108.50  monthly  for  one  hundred  infants,  a  saving  of  $395.25. 
over  the  cost  of  modified  milk. 

Trained  nurses — the  very  best — can  be  secured  for  $75.00  a 
month.  Nursery  maids  or  matrons,  trained  to  work  among  in- 
fants under  the  supervision  of  nurses,  can  be  secured  for  $40.00  a: 
month.  Dr.  R.  A.  Cooke,  who  has  been  working  with  the  Commit- 


[*  The  Committee,  as  had  been  stated,  paid  8^4  cents  a  quart  for  its 
whole  milk.  At  the  close  of  the  hot  weather,  the  substitution  of  inspected, 
milk  for  this  certified  milk  was  suggested  to  the  Association  of  Phy- 
sicians, working  in  connection  with  the  depots.  The  decision  was  that 
even  in  winter,  the  certified  milk,  representing  greater  purity  and  safety, 
should  be  continued.] 


68  A.  I.  C.  P. 

tee's  outside  nurse  at  East  105th  Street,  believes  that  one  trained 
nurse,  supervising  two  assistants  in  connection  with  physicians  and 
consultations,  can  thoroughly  instruct  and  follow  up  one  hundred 
babies.  In  other  words,  the  $271.25  saved  the  Committee  by  the 
substitution  of  15-cent  whole  milk  for  modified  milk  would  have 
paid  the  salary  of  two  nurses  and  three  assistants,  able,  accord- 
ing to  Dr.  Cooke's  estimate,  to  look  after  175  babies.  The 
saving  on  10-cent  milk  would  have  paid  the  salaries  of  two 
nurses  and  five  assistants  capable  of  looking  after  almost  225 
babies,  and  the  saving  on  /-cent  milk  would  have  paid  the  salaries 
of  two  nurses  and  six  assistants,  capable  of  looking  after  about 
250  babies. 

If  milk  costing  7  cents  a  quart  had  been  sold,  probably  a  large 
number  of  mothers  who  felt  they  could  not  afford  the  Committee's 
expensive  modified  milk,  would,  rather  than  accept  charity,  have 
paid  all  or  part  of  the  full  price,  and  would  thus  have  increased 
by  from  $50.00  to  $60.00  the  amount  expended  by  philanthropy 
not  only  upon  educating  the  mothers  and  improving  the  condi- 
tion of  their  infants,  but  in  raising  the  general  standard  of  their 
lives. 

The  problem  for  philanthropy  and  for  other  cities,  therefore,  is 
a  cheap,  clean  milk,  modified  only  when  mothers  are  too  ignorant 
to  be  intrusted  with  its  preparation  or  are  prevented  from  so 
doing  by  employment.  Both  kinds  of  milk  should  be  sold  from 
the  same  depot  where  physicians  should  instruct  mothers,  and 
nurses  assisted  by  nursery  maids,  matrons  or  visitors,  should 
follow  up  the  cases  in  the  homes. 

The  cleaner  the  milk,  the  more  lives  will  be  saved. 

The  cheaper  it  is,  the  more  money  will  be  spent  on  education; 
the  less  money  will  be  wasted  on  unnecessary  relief;  more  fam- 
ilies will  retain  their  self-respect  and  integrity,  and  the  whole 
standard  of  family  life,  of  such  vital  and  absolute  importance 
to  the  nation,  will  be  raised. 


New  York  Milk  Committee  69 

Experiment  No.  3. 

Can  Infant's  Milk  Depots  Be  Run  on  a  Business  Basis, 
and  If  Not,  In  How  Far  Will  Philanthropy  Be  Needed  To 
Support  Their  Work? 

The  first  part  of  this  question  (considering  infants'  milk 
depots  as  places  where  modified  milk  exclusively  is  sold)  is 
merely  another  way  of  asking  whether  modified  milk  can  be  pro- 
duced and  distributed  at  prices  which  poor  people  can  pay. 

To  this,  the  answer  is  definitely  No. 

Not  only  will  modified  milk,  prepared  under  the  most  economic 
conditions,  be  out  of  the  reach  of  a  great  number  of  poor  people, 
but  even  whole  milk,  were  it  possible  to  produce  a  guaranteed 
article  at  seven  cents  a  quart,  would  still  be  beyond  the  reach  of 
those  in  greatest  need.     Philanthropy  must  assist  either 

(a)  By  conducting  the  business  on  a  losing  basis,  rendering 
indiscriminate  assistance  through  reduced  prices  to  all; 
or 

(b)  By  actually  conducting  or  cooperating  with  an  enter- 
prise which  conducts  the  business  on  a  paying  basis,  ren- 
dering discriminating  assistance  through  actual  relief. 

In  either  case  the  amount  of  this  assistance  will  vary  accord- 
ing to  the  quantity  of  modified  or  whole  milk  sold  and  will  de- 
crease in  direct  proportion  to  the  increase  in  self-respect  and  in- 
telligence of  the  families  using  it.  But  to  increase  the  self-respect 
and  intelligence  of  the  families  using  it,  philanthropy  must  do 
something  more  than  hand  out  milk  tickets,  coupons  or  requisi- 
tions. It  must  educate — and  this  requires  first  of  all  that  it 
should  educate  itself. 

In  the  infants'  milk  depots,  supported  by  the  Milk  Committee, 
and  in  others  to  a  greater  or  less  extent,  not  only  has  milk  been 
bought,  modified  and  sold,  but  nurses  have  been  employed,  poor 
people  have  been  relieved,  statistics  have  been  compiled,  instruc- 
tion has  been  given,  home  visits  have  been  made  and  a  number 
of  other  matters  have  been  attended  to.  In  other  words,  the  Com- 
mittee has  been  engaged  in  business,  philanthropy,  medicine,  sani- 
tation, statistics  and  education,  and  it  goes  without  saying  that  it 
has  done  no  one  part  of  the  work  as  well  as  it  would  have  been 
done  had  not  the  others  at  the  same  time  engrossed  its  attention. 


70  A.  I.  C.  P. 

To  carry  on  a  true  program  of  education — in  other  words  to 
wage  a  successful  campaign  against  infant  mortality — it  seems 
necessary  to  segregate  the  different  departments  of  the  under- 
taking, letting  each  be  managed  separately  but  in  cooperation 
with  all  the  others,  and  coordinated  by  a  joint  executive  board  or 
board  of  management.  Ideally,  this  should  be  under  the  super- 
vision of  the  municipality. 

The  departments  in  which  the  work  should  be  divided  are  as 
follows : 

(i)     The  production,  handling  and  sale  of  the  milk  (busi- 
ness). 

(2)  The  investigating  and  relief  of  necessitous  cases  (phil- 
anthropy). 

(3)  The  feeding  and  instruction   of   mothers   and   babies 
(medical). 

(4)  The  "follow-up"  and  statistical  work  (social  or  muni- 
cipal). 

(1)  The  Production,  Handling  and  Sale  of  the  Milk:  (Business)  : 
Under  the  first  head  the  turning  over  of  the  business  end  of 
the  undertaking  to  a  strictly  milk  enterprise  seems  highly  desir- 
able. Such  an  enterprise,  enlarging  on  the  Copenhagen  plan* 
could  provide  milk  (and  perhaps  a  few  other  dairy  supplies  such 
as  eggs  and  butter)  for  nursing  mothers  and  for  children  under 
five  years  of  age,  and  could  set  a  standard  for  other  milk  com- 
panies in  producing  and  selling  under  sanitary  conditions  a  cheap, 
clean  milk — the  crying  need  of  the  tenement  districts  of  every  city. 
Whole  milk  as  well  as  modified  milk  should  be  sold,  the  latter  of 
which,  to  save  expense,  could  be  pasteurized  and  modified  ac- 
cording to  the  doctor's  instructions  in  the  home.  The  price  set 
upon  the  milk  should  be  one  dictated  by  terms  of  fair  business 
competition.  Never  should  the  milk  be  sold  below  cost  or  at  less 
than  a  fair  profit.  Should  those  in  control  wish  to  set  aside  any 
or  all  of  their  earnings  for  the  benefit  of  their  patrons,  they 
should  do  so,  not  in  such  a  way  that  the  milk  dealer,  whose  liveli- 
hood depends  upon  each  dollar  of  profit,  would  be  injured,  but 
in  an  actual  cash  contribution  for  relief,  to  be  administered 
through  an  efficient  and  discriminating  relief  agency.     The  right 


See  note,  page  81. 


New  York  Milk  Committee  71 

to  do  what  they  will  with  their  earnings  is  obvious,  but  phil- 
anthropists have  no  right,  by  selling  below  cost  or  below  a  fair 
profit,*  to  help  those  who  do  not  need  to  be  helped  and  thus  tempt 
or  force  them  to  become,  in  effect,  recipients  of  charity.  Such  a 
procedure  encourages  pauperism,  diverts  money  from  useful  to 
harmful  channels,  and  injures  legitimate  business  by  bidding  for 
the  regular  dealer's  customers  on  terms  which  he  cannot  meet. 

Selling  milk  below  cost  or  at  less  than  a  fair  profit  also  creates 
not  only  a  false  idea  of  the  value  of  that  particular  milk,  but  of 
all  milk  whose  price  is  determined  by  the  time  and  effort  expended 
in  securing  its  purity  and  safety.  Such  a  procedure  is  bad  milk 
education. 

But  while  the  enterprise  should  be  fair,  it  should  not  forget 
that  it  is  endeavoring,  on  terms  of  just  but  rigorous  competi- 
tion, to  establish  new  standards,  and  that  it  is  particularly  in 
search  of  a  cheap,  clean  milk  for  the  tenements.  Such  a  milk,  the 
Committee  believes,  may  yet  be  obtained. 

Dr.  Charles  E.  North,  of  the  Executive  Committee  of  the  Milk 
Committee,  in  his  pamphlet  entitled  "A  Method  of  Milk  Pro- 
duction," explains  how  a  milk,  drawn  from  non-tuberculous  cows, 
and  equal  in  its  bacteriological  count  to  certified  milk  (in  other 
words,  meeting  the  requirements  of  the  New  York  Health  De- 
partment's newly  classified  "guaranteed"  milk),**  may  be  pro- 
duced at  a  slightly  increased  cost  at  the  farm.  Hitherto  the  prob- 
lem has  been  how  to  transport  this  milk  to  the  city  and  keep  it 
clean.  Mr.  Provost  of  the  Lederle  laboratories  has,  at  the  request 
of  the  Milk  Committee,  constructed  a  milk  can  which  seems  to 
meet  the  problem.  This  can,  a  patent  for  which  is  being  pro- 
cured, is  provided  with  a  detachable  faucet,  from  which  the  milk 
can  be  drawn  at  the  station  into  a  single  service  paper  or  wooden 
bottle,  and  is  so  arranged  that  having  been  sealed  at  the  cream- 
ery or  dairy  where  it  is  washed  and  sterilized,  "burglarizing" 
or  adulteration  is  rendered  absolutely  impossible.  In  order 
thoroughly  to  mix  the  milk,  the  can,  by  a  simple  arrangement. 


[*As  the  Milk  Committee  in  effect,  has  done.] 

[♦♦Guaranteed  milk  corresponds  to  certified  milk  except  that  it  is  pro- 
duced under  the  rules  and  regulations  of  the  New  York  Health  Depart- 
ment instead  of  the  Milk  Commission  of  the  County  Medical  Society.] 


New  York  Milk  Committee  73 

is  attached  to  a  compartment  containing  compressed  air, 
which  has  been  pumped  into  it  through  a  cotton  strainer,  and  is 
absolutely  sterile.  By  shipping  direct  from  the  dairy  to  the  milk 
station,  and  thus  avoiding  the  cost  of  bottling,  freightage  on 
bottles,  breakage,  washing  and  sterilizing  of  bottles  and  additional 
handling  in  the  city,  this  milk  which  Dr.  North  believes  should 
contain  less  than  10,000  bacteria  per  c.  c.  in  a  raw  state,  and 
which  could  be  pasteurized  at  a  great  economy  to  poor  people  in 
the  home,*  could  be  sold  at  a  very  cheap  rate,  possibly  as  low  as 
seven  cents  a  quart. 

With  the  equipment  and  buildings,  found  in  most  large 
cities,  for  the  handling  and  sale  of  both  whole  and  modified 
milk,  the  expense  of  conducting  enough  infants'  milk  depots 
to  meet  all  demands  should  not  include,  from  the  City  standpoint, 
much  more  than  the  purchase  of  cans,  the  installation  of  new 
depots  and  the  cost  of  delivery.**  By  securing  the  cooperation  of 
a  certain  number  of  farmers  to  produce  milk  according  to  Dr. 
North's  method  the  establishment  of  a  sufficient  number 
of  infants'  milk  depots  to  feed  as  many  babies  as  circumstances 
require  should  not  be  difficult.  The  control,  by  the  milk  enter- 
prise, of  a  model  dairy  or  dairies,  either  owned  by  it,  or  working 


[*Mr.  Nathan  Straus  has  recently  invented  a  very  excellent  home  pas- 
teurizer, which  he  hopes  to  place  on  the  market  for  the  price  of  $1.00.] 

[**A  model  milk  concern  with  a  maximum  daily  capacity  for  handling 
8,000  quarts  of  whole  milk  and  modified  milk  for  1,000  infants,  and  an 
average  capacity  sufficient  to  supply  twenty  depots  selling  300  quarts  daily 
of  whole  milk,  and  providing  milk  for  from  twenty-five  to  forty  babies 
each,  could  be  organized,  equipped,  and  maintained  until  it  was  on  its 
feet,  with  a  capital  of  from  $75,000,  to  $100,000. 

If,  by  the  combined  influence  of  education,  example  and  financial  induce- 
ments, such  a  concern  could  elevate  a  community  of  unclean  milk  pro- 
ducers to  satisfactory  standards ;  if  it  could  handle  that  milk  in  a  creamery 
remodelled  from  an  old  run-down  creamery  along  the  most  sanitary  and 
economical  lines;  if  it  could  make  its  own  terms  for  transportation  by 
railroad  and  for  delivery  in  the  city;  if  it  could  equip  and  maintain  its 
own  model  stores,  and  at  the  end  of  a  definite  period  of  time,  if  it  could 
issue  an  illustrated,  "before  and  after"  report  showing,  item  by  item,  in 
just  how  far  it  had  succeeded  in  producing  milk  of  a  high  standard,  selling 
it  at  a  fair  profit,  and  yet  bringing  the  price  of  this  milk  within  the  reach 
of  poor  people, — if  a  milk  concern  could  do  this,  it  would  achieve  more 
than  a  mere  commercial  success,  for  it  would  educate  along  the  broadest 
and  most  useful  lines.] 


74  A.  I.  C.  P. 

in  cooperation  with  it,  under  the  supervision  of  the  Health  Depart- 
ment, is,  likewise,  ideally  desirable.  These  matters  would  work 
themselves  out  when  men  concerned  in  the  milk  business,  phil- 
anthropists, physicians,  and  sanitarians  once  got  together  on  the 
subject. 

The  location  of  the  depots  is  a  matter  deserving  careful  consider- 
ation. When  attached  to  dispensaries  and  settlements  their  use- 
fulness is  greatly  increased,  as  they  are  then  combined  with  val- 
uable supplementary  activities  and  interests.  The  giving  of 
rooms,  rent  free,  by  these  institutions,  is,  however,  undesirable,  as 
it  immediately  constitutes  a  philanthropic  subsidy  against  which 
legitimate  business  cannot  compete.  If  the  institution  is  able  and 
wishes  to  contribute  the  room,  the  milk  business  should  pay  a 
fair  rental,  which  the  institution  might  apply  in  any  way 
which  it  might  deem  advisable.  Similarly,  if  space  in  the  stores  is 
occupied  for  philanthropic  purposes,  rent  should  be  charged  to  the 
agency  employing  such  space,  provided  that  the  good  will  of  this 
agency  does  not  offset  the  nominal  rent  fee.  This  could  be  deter- 
mined by  the  cooperating  parties.* 

(2)     The  Investigating  and  Relief  of  Necessitious  Cases 
(Philanthropy)  : 

Given  a  clean  whole  milk  and  a  minimum  of  high  grade  mod- 
ified milk,  sold  at  as  low  a  price  as  the  terms  of  fair  competi- 
tion will  permit,  the  next  step  is  to  see  that  no  woman,  young 
child  or  infant  in  New  York  City  who  needs  that  milk,  is 
deprived  of  it.  Here  is  the  problem  for  philanthropy.  If  the 
milk  is  sold  at  a  fair  profit,  and  if  the  needs  of  the  entire  city 
are  to  be  met,  the  call  upon  relief  agencies  will  be  great.  At  the 
same  time  a  big  economy  will  be  effected  by  selling  more  whole 
milk  and  less  modified  milk,  for  most  mothers  can  and  will  pay 

[*  The  Committee  is  engaged  at  present  in  working  out  the  interior 
arrangement  of  a  model  depot  at  202  Henry  Street.  In  the  front  of  this 
depot  it  proposes  to  dispense  whole  and  modified  milk,  leaving  space  in  the 
rear  for  the  consultations,  and  for  conferences  between  mothers  and 
nurses.  Several  ideas  which  have  grown  out  of  the  Committee's  ex- 
periences will  be  incorporated  in  this  depot  which  will  be  open  at  all 
times  to  those  who  may  wish  to  visit  it.] 


New  York  Milk  Committee  75 

for  whole  milk — increasingly  so  as  they  are  educated  to  know  its 
worth.  The  ultimate  call  upon  philanthropy  will  also  be  less  than 
it  would  be  if  it  were  conducting  the  business  itself,  and  if  the 
milk — both  whole  and  modified — were  sold  below  cost  or  below  a 
fair  profit,  because  in  that  case  many  non-necessitous  people 
would  be  relieved,  the  profit  on  whose  payments  could  be  used  in 
behalf  of  the  really  indigent. 

Clearly  distinguishing  between  business  and  philanthropy  would 
accomplish  two  things : 

(1)  It  would  show  the  public  definitely  how  widespread  is 
the  state  of  undernourishment  on  the  part  of  pregnant  mothers, 
nursing  mothers,  infants,  and  young  children  in  New  York  City, 
and  give  it  some  clear  idea  of  its  responsibility ;  and 

(2)  It  would  educate  and  give  poor  people  a  means  of  dis- 
tinguishing between  bad  and  good  milk,  between  nourishing  and 
hurtful  food,  between  true  and  false  dietetic  economy. 

These  two  lessons — the  lesson  of  a  great  need  on  the  one  hand, 
and  the  importance  of  good,  wholesome  food,  on  the  other — 
sorely  need  preaching  to  the  rich  and  poor  alike.  Any  plan,  sys- 
tem or  method  in  which  a  sharp  distinction  is  not  drawn  between 
business  and  philanthropy  conceals  these  facts,  and  thus  deceives 
the  public  and  the  consumer  as  to  the  true  state  of  affairs. 

The  milk  company  should  be  thoroughly  in  cooperation  with 
every  relief  agency,  settlement,  church,  and  social  organization  in 
New  York  City,  whose  trained  visitors,  workers  or  investigators 
would  determine  whether  the  cases  in  their  care  should  pay  full 
price,  part  price  or  nothing  at  all  for  the  milk.  Each  mother 
should  be  required  to  pay  something,  however  small,  if  she  were 
able,  the  really  needy  cases,  of  course,  receiving  the  milk  free.  In 
this  way  the  danger  of  imposition  on  the  one  hand,  and  neglect 
on  the  other,  would  be  avoided  and  a  standard  of  efficient  and 
discriminating  relief  would  be  established.  Regularly  itemized 
bills  could  be  rendered  by  the  depot  to  the  proper  agency  for  the 
amount  over  and  above  that  which  it  had  been  determined  the 
mother  could  pay  for  the  milk. 


76  A.   I.   C.   P. 

(3)     The  Feeding,  Instructional  and  Statistical  Work 
(Medical)  : 

Having  secured  the  cooperation  of  the  milk  business  and  phil- 
anthropic organizations,  it  would  be  necessary  to  secure  the  con- 
fidence of  all  physicians  and  to  enlist  their  interest  in  the  work. 
This  could  be  done  by  placing  every  detail  of  the  milk  company's 
business  from  the  testing  of  cans  and  the  operations  of  milking, 
straining,  etc.,  at  the  farm,  to  the  modification  of  the  milk  and 
its  delivery  in  the  city,  under  the  supervision  of  the  Health  De- 
partment, and  by  securing  the  approval  of  the  Academy  of  Medi- 
cine for  the  general  instructional  and  preventive  work  carried  on 
in  the  depots.  Further  cooperation  could  be  secured  by  making 
it  possible  for  any  physician  to  refer  a  private  patient  to  the 
depots  for  milk,  modified  according  to  his  prescription,  turning 
over  the  indigent  cases  to  the  physicians  who  would  hold  classes 
for  the  instruction  of  the  mothers  in  connection  with  the  depots. 
In  this  way  free  instruction  and  relief  would  be  given  only  to  those 
who  needed  it,  and  the  scope  of  the  work  would  quickly  and  au- 
tomatically adjust  itself. 

Each  depot  should  be  under  the  charge  of  a  senior  physician, 
selected  in  such  a  manner  that  the  other  physicians  of  the  neigh- 
borhood would  have  confidence  in  and  would  cooperate  with  him. 
Such  a  physician  might  be  a  volunteer,  or  he  might  be  provided 
by  the  municipality — but  in  any  case,  to  secure  perfect  coopera- 
tion, his  selection  should  meet  with  the  approval  of  those  with 
whom  he  would  have  to  work,  and  his  duties  should  be  such 
as  not  to  infringe  in  any  way  upon  the  private  practice  of  these 
men.  If  he  were  from  the  municipality  he  could  easily  conduct 
classes  for  as  many  babies  as  the  depot  could  handle.  If  he  were 
a  volunteer  physician,  he  would  need  assistants,  chosen  with  equal 
care. 

The  instructional  capacity  of  the  depot  should  be  thought  out 
carefully,  and  the  work  of  doctors  as  well  as  nurses  should  be 
viewed  from  the  standpoint  of  maximum  efficiency  in  securing 
permanent  results.  Most  volunteer  physicians,  the  Committee 
has  found,  cannot  as  a  rule  afford  to  give  more  than  one  class 


New  York  Milk  Committee  77 

or  consultation  weekly,  and  few  feel  that  they  are  able  at  this 
class  to  attend  thoroughly  to  more  than  ten  or  fifteen  babies. 
Others  are  willing  to  devote  more  time  and  strength.  The  in- 
structional work,  therefore,  which  the  depot  can  undertake  de- 
pends entirely  on  the  number  of  physicians  who  give  their  ser- 
vices, the  amount  of  time  contributed  by  them,  and  the  number 
of  nurses  with  nursery  maids,  matrons  or  visitors  under  them, 
provided  by  philanthropy  or  the  municipality  to  assist  the  phy- 
sicians. 

As  to  the  difficulty  of  obtaining  volunteer  physicians  that,  judg- 
ing by  the  Milk  Committee's  experience,  should  not  be  great. 
Perhaps  there  is  no  class  of  men  more  generous,  altruistic,  or 
more  deeply  stirred  by  the  suffering  about  them  than  the  doctors 
who  work  in  the  tenements  of  any  city.  On  July  26th,  when  the 
physicians,  giving  classes  of  instruction  in  connection  with  the 
Committee's  milk  depots,  came  together  to  organize  the  Associa- 
tion of  Physicians  of  the  New  York  City  Milk  Depots,  sixteen  out 
of  twenty-nine  were  present ;  this,  in  spite  of  the  fact  that  the  day 
was  hot,  the  hour  not  convenient  for  all  of  them,  and  that  many 
were  absent  on  their  vacations.  This  is  fairly  indicative 
of  the  spirit  which  actuates  the  profession.  Many  doctors, 
of  course,  know  little  or  nothing  about  infant  feeding.  Yet  the 
lives  of  the  tenement  babies — the  most  endangered  lives  of  the 
community — are  in  their  trust.  With  their  eagerness  to  learn, 
their  enthusiasm  and  their  high  motives  for  the  work,  these  phy- 
sicians— young  men  mostly,  of  all  nationalities — constitute  a  tre- 
mendous, potential  force  for  the  reduction  of  infant  mortality. 
They  wish  to,  and  they  should  be  utilized. 

(4)     The   "Follow   Up"   and   Statistical  Work 
(Social  or  Municipal)  : 

The  fourth  and  last  cooperating  factor  in  the  scheme  is  an  able 
and  competent  force  of  nurses.  These  nurses  should  be  "direc- 
tresses of  the  depots,"  devoting  their  energies  to  the  "classes" 
and  follow-up  work — not  in  handing  out  bottles  or  rendering  ac- 
counts. They  should  be  the  coordinating  units,  joining  the  san- 
itary, medical,  social  and  municipal  interests  in  the  depots.  Their 
babies  would  come — would  be  sent — to  them.    Consequently  they 


78  A.  I.  C.  P. 

would  not  be  regarded  as  intruders  and  unwelcome  guests  when 
they  visited  the  homes.  They  would  be  social  workers,  persons  of 
importance  in  their  neighborhoods,  carrying  on  a  fine  and  sym- 
pathetic, because  natural,  work. 

By  holding  the  nurses  responsible  for  the  health  and  lives  of 
the  actual  babies  under  them,  there  would  be  less  likelihood  of 
perfunctory  service,  as  is  the  case  when  results  are  measured  by 
numbers  and  quantity.  With  the  milk  as  a  drawing  card,  the 
nurses  would  obtain  that  "hold"  upon  the  mothers,  the  lack  of 
which  was  felt  so  keenly  by  the  Committee's  "outside"  nurses 
during  the  past  summer.  By  being  relieved  of  bookkeeping  and 
the  sale  of  the  milk,  they  would  have  that  time  and  freedom,  the 
lack  of  which  so  seriously  hampered  the  depot  nurses. 

The  nurses  should  be  held  responsible  for  the  statistics  in 
their  individual  depots.*  In  this  they  would  cooperate  with  the 
senior  physician  and  his  assistants,  each  of  whom  naturally 
would  take  an  interest  in  the  health  and  progress  of  his  own 
babies.  By  this  arrangement  it  would  be  possible  for  any  phy- 
sician or  nurse  to  compare  the  work  done  at  any  consultation 


[*  In  carrying  on  statistical  work  in  connection  with  social  enterprises 
two  dangers  present  themselves — first,  the  danger  of  making  the  work  so 
thoroughly  scientific  that  the  object  of  winning  people's  hearts  for  their 
own  betterment  is  quite  forgotten ;  and  second,  the  danger  of  loose,  care- 
lessly gathered,  and  slovenly-handled  facts,  which  bother  and  impede  to  a 
less  degree  than  the  really  valuable  facts,  gathered  in  a  scientific  manner, 
but  which  in  the  end  are  of  no  value  whatever. 

The  thing  to  be  determined  then,  is  first,  does  one  wish  to  collect  facts, 
and  second,  how  many  facts,  what  facts,  and  for  what  purpose  does  he 
wish  to  collect  them ;  and  how  much  money  is  he  willing  to  spend  upon 
them?  If  facts  are  worth  anything,  they  are  worth  getting.  This  requires 
time.  If  they  are  worth  getting,  they  are  worth  getting  right.  This  re- 
quires preparation  and  supervision.  If  they  are  worth  getting  right,  they 
are  worth  handling  right.  This  requires  analysis.  If  the  results  are  to  be 
valuable  (that  is,  are  not  going  to  be  upset  by  the  omission  of  some  essen- 
tial factor,  or  by  some  ridiculous,  unscientific  and  lame  conclusion),  prep- 
aration, supervision,  and  analysis  must  be  the  work  of  an  expert  statistic- 
ian, or  at  least  of  some  person  having  the  criticism  and  advice  of  an  expert 
statistician.  Time  is  the  contribution  of  the  collector,  taken  if  it  be  a 
nurse  (like  the  Committee's  nurses),  from  her  other  work. 

Now,  the  "other  work"  of  the  nurses  is  to  save  lives — to  prevent  death 
by  means  of  education.  But  to  prevent  by  education,  one  must  educate  to 
prevent ;  to  educate  to  prevent,  one  must  study  facts,  and  to  study  facts, 
one  must  obtain  them.  The  problem  of  statistics  versus  service,  therefore, 
is  simply  one  of  choice  and  expenditure,  in  terms  of  ultimate   results.} 


Xew  York  Milk  Committee  79 

or  depot,  with  that  at  any  other.  This  would  place  a  premium  on 
individual  effort  and  would  introduce  the  important  element  of 
personal  emulation,  usually  lacking  where  things  are  over-sys- 
temized. 

While  the  sending  of  relief  visitors  into  the  same  home  which 
the  nurses  visit  seems  like  a  duplication  of  effort,  it  is  necessary, 
at  least  until  the  time  comes,  when,  in  addition  to  their  profession- 
al ability,  nurses  acquire  the  qualification  of  social  workers  as 
well.  Nurses  just  entering  field  work,  keenly  sensitive  as  they 
are  to  the  suffering  about  them,  are  apt  to  let  their  sympathies 
run  away  with  their  judgment  when  it  comes  to  passing  upon 
the  economic  status  of  a  poor  family ;  and,  apart  from  this,  relief 
agencies  which  are  dispensing  thousands  of  dollars  yearly  would 
not  be  faithful  to  their  trust,  did  they  not  dispense  that  money 
efficiently,  discriminatingly,  through  those  whose  judgment  they 
trust.  There  is  no  reason  why  trained  nurses  should  not  be 
trained  social  workers,  as  well;  in  fact,  both  from  the  stand- 
point of  economy  and  results,  there  is  every  reason  why  they 
should  be  trained  social  workers.  But  until  this  social  training 
is  acquired,  and  so  long  as  the  philanthropy,  society,  or 
municipality  which  pays  their  salaries  is  not  that  which  furnishes 
the  money  for  relief,  a  division  of  labor,  even  at  the  expense  of 
its  multiplication,  is  unavoidable. 


80  A.  I.  C.  P. 

SUMMARY. 

No  difference  has  been  shown  between  the  nutritive  values  of 
raw  and  pasteurized  milk  in  the  brief  period  so  far  covered  by  the 
Committee's  experiment.  From  the  standpoint  of  safety,  pasteur- 
ized milk  has  given  the  most  satisfactory  results. 

Independent  nurses,  doing  purely  instructional  work,  can  ac- 
complish more  than  nurses  whose  time  is  largely  occupied  with 
dispensing  modified  milk,  but  free  nurses,  connected  with  infants' 
milk  depots,  because  of  the  hold  which  the  dispensation  of  milk 
gives  them  upon  ignorant  mothers,  can  accomplish  more  than 
either  of  the  other  two. 

Whole  milk  should  be  sold  in  conjunction  with  modified  milk 
in  infants'  milk  depots  for  the  following  reasons : 

(a)  Because,  the  exclusive  sale  of  modified  milk  discourages 
breast  feeding. 

(b)  Because,  wherever  possible,  home  modification  of  whole 
milk  is  desirable  from  an  educational  standpoint. 

(c)  Because,  the  substitution  of  whole  milk  for  modified 
milk  means  a  big  economy  to  poor  mothers  and  philanthropists, 
the  latter  of  whom  could  devote  to  educational  purposes  money 
which  is  often  spent  needlessly  on  modified  milk. 

Viewed  from  the  standpoint  of  their  united  activities,  infants' 
milk  depots  cannot  be  supported  without  philanthropic  assistance, 
rendered,  either 

(a)  Through  reduced  prices  and  business  losses,  or 

(b)  Through  direct  relief. 

The  best  method  seems  to  be  to  sell  the  milk  on  a  business  basis 
in  cooperation  with  physicians,  philanthropists,  social  workers 
and  the  municipality. 

The  benefits  of  such  an  arrangement  would  be : — 


New  York  Milk  Committee  8i 

(a)  All  forces  would  work  in  harmony. 

(b)  Legitimate  business  would  not  be  injured. 

(c)  A  "standard"  would  be  set  for  other  milk  concerns. 

(d)  Non-necessitous  cases  would  not  be  "relieved"  by  be- 
low-cost purchases. 

(e)  Relief  would  be  carried  on  efficiently  and  with  just 
discrimination  by  relief  agencies. 

(f)  Society  would  be  rightfully  informed  about  the  great 
problem  of  undernourishment. 

(g)  People  ignorant  of  the  value  of  milk  would  not  be  kept 
in  ignorance. 

(h)  By  accepting  only  necessitous  cases  for  relief  and  in- 
struction, the  scope  of  the  work  for  philanthropy,  phy- 
sicians and  nurses  would  automatically  adjust  itself. 

(i)  By  placing  responsibility  on  each  depot,  physician  and 
nurse,  the  advantage  of  "personal  emulation"  would  be 
secured. 

(j)  By  "holding"  the  mothers,  permanent  educational  results 
would  be  secured. 

(k)  By  gathering  statistics  and  by  wide  observation,  im- 
portant facts  about  infant  feeding  and  the  conditions 
affecting  the  lives  of  mothers  and  children  would  be  as- 
certained and  the  way  paved  for  a  more  effective  cam- 
paign against  infant  mortality. 


The  Copenhagen  Milk  Supply  Association  was  founded  in  1878  by 
a  group  of  philanthropists  whose  object  was  to  supply  Copenhagen  with 
milk  which  should  be  above  suspicion  as  to  purity  and  cleanliness.  Three 
classes  of  milk  are  supplied — ordinary  commercial  milk,  from  herds  free 
from  tuberculosis  and  under  constant  supervision  of  the  Company's  in- 
spectors ;  milk  for  children  supplied  from  herds  carefully  picked  and 
more  rigidly  guarded  than  those  supplying  ordinary  commercial  milk, 
and  milk  for  nurslings  produced  under  the  most  rigid  hygienic  standards 
and  modified  according  to  standard  formulae  and  to  the  formulae  of 
physicians  to  meet  the  peculiar  conditions  of  infancy.  It  was  early  dis- 
covered that  this  class  of  milk  could  not  be  produced  successfully  by 
farmers.  Accordingly,  another  company  was  organized,  but  although 
the  herds  supplying  the  infants'  milk  are  under  direct  supervision  of 
this  sub-company,  the  handling  of  the  milk  is  as  far  as  practicable  carried 
on  by  the  original  company.  Through  the  generosity  of  public  spirited 
citizens  as  well  as  of  those  in  control  of  the  milk  company,  which  meets 
deficits  out  of  the  profits  of  the  other  branches  of  the  supply,  the  price 
fixed  with  infants'  milk  is  extremely  low,  and  at  times  the  milk  is  dis- 
pensed gratuitously. 


MUTUAL  MILK 
and  CREAM  CO. 


Receivers  and  Distributors 
Pure  Milk,  Cream  and  Con- 
densed Milk;  Pasteurizing 
and  Bottling  done  at  all  Plants 


Principal  Office 
214-224  East  22nd  Street,  New  York  City 

(322-326  East  103rd  Street 

Branches     -    J  321-325  East  102nd  Street 

(  348-352  East  142nd  Street 


Walker-Gordon  Milk  Laboratories 

ARE  ESTABLISHED  IN 

Boston  New   ^  ork  Baltimore  Buffalo 

Chicago  (  Irveland  Detroit  Indianapolis 

Montreal,  Can.  Ottawa,  Can.  Pittsburg  St.  Louis 

Toronto.  Can.  Washington,  D.C.  London,   Eng. 

SPECIAL  DEPOTS 
Philadelphia  Atlanta   Ckj  WeH  End.  N.J. 

EM  K  I. 

793  Boylston  Street.  Boston.  Maw. 

NEW   YORK    OFFICE   &    LABORATORY 

Cor.  Madis  >n    \\»nue  and  52n  \  St: 


TELEPHONE  CONNECTION 


II 


THE 
J.   H.  PADDOCK    COMPANY 

MANUFACTURERS    OF 
CORKS    AND    CORK    SPECIALTIES 


82-92   THIRD   STREET  BROOKLYN.    NY. 


DATE  DUE 

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